冯月英 盛净 曹国良 戴蓉芳

[摘要] 目的 探討糖化血红蛋白（HbA1c）在动脉粥样硬化发生、发展中的作用。 方法 选择2015年1月～2016年12月上海交通大学医学院附属第九人民医院收治的120例冠心病（CHD）患者及40例健康体检者（对照组），据冠脉造影结果进行分组，其中120例CHD患者包括急性心肌梗死组（AMI组）40例、不稳定型心绞痛组（UAP组）40例、稳定型心绞痛组（SAP组）40例。采用彩色多普勒超声诊断仪测定颈动脉内膜-中层厚度（IMT）；采用数字减影心血管造影机行选择性冠状动脉造影，应用Gensini冠状动脉病变积分方法评价冠状动脉病变严重程度；采用酶法测定HbA1c、血脂等指标。 结果 AMI组、UAP组、SAP组患者HbA1c水平及IMT均显著高于对照组（P < 0.01）；且AMI组、UAP组患者HbA1c水平明显高于SAP组患者（P < 0.01）；AMI组、UAP组患者IMT明显高于SAP组患者（P < 0.05）；AMI组和UAP组患者HbA1c、IMT两指标比较，差异无统计学意义（P > 0.05）。CHD患者HbA1c水平与冠状动脉狭窄程度呈正相关（r = 0.516，P < 0.05）。 结论 HbA1c可独立预测冠状动脉病变程度，并进一步促进动脉粥样硬化的发展，HbA1c在冠状动脉粥样硬化发生及发展中起重要作用，监测其水平变化对于CHD的诊断、病情判断及预后评估均有重要意义。

[关键词] 冠心病；急性心肌梗死；不稳定型心绞痛；颈动脉内膜-中层厚度；糖化血红蛋白

[中图分类号] R541 [文献标识码] A [文章编号] 1673-7210（2018）08（a）-0085-04

[Abstract] Objective To explore the significance of glycosylated hemoglobin （HbA1c） in the occurrence and development of atherosclerosis. Methods Totally 120 patients with coronary heart disease， including 40 patients with acute myocardial infarction （AMI group）， 40 patients with unstable angina （UAP group） and 40 patients with stable angina （SAP group）， were enrolled in Shanghai Ninth People′s Hospital， Shanghai Jiaotong University School of Medicine from January 2015 to December 2016， and compared with those of 40 healthy subjects in the control group， grouped by the results of selective coronary angiography. Color Doppler ultrasound diasonograph was used to detect carotid intima media thickness （IMT）. Digital subtraction angiography was used to perform the selective coronary angiography， and Gensini coronary disease score method was used to evaluate the severity of the coronary artery lesion. Enzymic method was used to detect the level of glycosylated hemoglobin and blood lipid. Results The levels of HbA1c and IMT in AMI group， UAP group and SAP group were significantly higher than those in control group （P < 0.01）， and the levels of HbA1c in AMI group and UAP group were significantly higher than those in the SAP group （P < 0.01）. IMT in AMI group and UAP group were significantly higher than those in the SAP group （P < 0.05）. Both the levels of HbA1c and IMT had no significant difference between AMI group and UAP group （P > 0.05）. The correlation between the level of HbA1c and the degree of coronary artery stenosis was positive in patients with coronary heart disease （r = 0.516， P < 0.05）. Conclusion The level of HbAlc is independently associated with the severity of the coronary stenosis， and further accelerates the development of atherosclerosis. HbA1c plays an important role in the occurrence and development of coronary atherosclerosis. By Monitoring the level change of HbA1c， there will be important significance to the condition judgment and prognosis evaluation in patients with coronary heart disease.

[Key words] Coronary heart disease； Acute myocardial infarction； Unstable angina； Carotid intima media thickness； Glycosylated hemoglobin

随着人们饮食结构的改变及生活质量的提高，我国冠状动脉粥样硬化的发病率呈现逐年递增的趋势[1]。冠状动脉粥样硬化与多种因素有关，严重者可导致冠状动脉粥样硬化性心脏病[2-3]。冠状动脉粥样硬化性心脏病是严重危害人类健康的常见病和多发病，其病理基础是动脉粥样硬化。动脉粥样硬化的早期预防和治疗对于改善患者预后和降低病死率具有重要意义。目前，颈动脉内膜-中层厚度（IMT）、超敏C反应蛋白及糖化血红蛋白（HbA1c）已成为研究冠状动脉粥样硬化的热点[4]。有证据证明糖代谢异常是动脉粥样硬化的独立危险因素[5]，糖基化终末产物促进动脉粥样硬化的发展[6]。……