鲁明兰,柯亭羽

目的：讨论2型糖尿病（T2DM）合并冠心病（CHD）患者的临床特征及其独立危险因素。方法：招募90名T2DM患者，分为单纯T2DM组（n=30）和2型糖尿病合并冠心病（Type 2diabetes mellitus with Coronary Heart Disease，T2DM&CHD）组（n=60）。采集人口学数据，生物指标和并发症等方面的资料。采用单因子及多因子Logistic回归，以确定独立危险因素。研究结果：T2DM&CHD组患者年龄较大、糖尿病的病程较长，总胆固醇（TC）水平较高、甘油三酯（TG）水平较高、低密度脂蛋白胆固醇（LDL-C）水平较高，脂蛋白（a）(Lp(a)）水平较高，高血压、胰岛素抵抗及颈动脉斑块比例较高（P<0.05）。多因素分析提示，年龄（OR=1.359）、高血压（OR=1.804）、TC（OR=1.508）、LDL-C（OR=1.211）、Lp(a）（OR=1.081）和糖化血红蛋白（HbA1c）（OR=1.129）是T2DM患者发生CHD的独立危险因素。结论：T2DM&CHD患者表现出以高龄、高血压、血脂代谢严重紊乱、长期血糖控制不佳为特征的临床谱。临床实践中应对具有上述特征的T2DM患者进行早期重点筛查与强化综合管理。

2型糖尿病；冠心病；危险因素；临床特征；Logistic回归

[1] Low Wang C.C.,Hess C.N.,Hiatt W.R.,et al.Clinical Update:Cardiovascular Disease in Diabetes Mellitus:Atherosclerotic Cardiovascular Disease and Heart Failure in Type 2 Diabetes Mellitus-Mechanisms,Management,and Clinical Considerations.Circulation.2016; 133(24):2459-2502. [2] Marx N,Federici M,Schütt K,et al.2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes.Eur Heart J.2023;44(39):4043-4140. [3] Arnett D K,Blumenthal R S,Albert M A,et al.2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease:A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Circulation.2019; 140(11):e596-e646. [4] Cai X,Liu X,Sun L,et al.Prediabetes and the risk of heart failure:A meta-analysis.Diabetes Obes Metab.2021,23(8):1746-1753. [5] Tsimikas S,Stroes E S G.The dedicated"Lp(a)clinic":A concept whose time has arrived?Atherosclerosis.2020;306:22-28. [6] Reyes-Soffer G,Ginsberg H N,Berglund L,et al.Lipoprotein(a):A Genetically Determined,Causal,and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease:A Scientific Statement From the American Heart Association.Arterioscler Thromb Vasc Biol.2022; 42(1):e48-e60. [7] 中国2型糖尿病防治指南(2020年版)编写委员会.中国2型糖尿病防治指南(2020年版).中华糖尿病杂志.2021;13(4):315-409. [8] American Diabetes Association.10.Cardiovascular Disease and Risk Management:Standards of Care in Diabetes—2024.Diabetes Care.2024,47(Suppl 1):S179–S218. [9] 中国高血压防治指南修订委员会.中国高血压防治指南(2018年修订版).心脑血管病防治.2019;19(1):1-44. [10] Wallace T M,Levy J C,Matthews D R.Use and abuse of HOMA modeling.Diabetes Care,2004;27(6):1487-1495. [11] Grundy S M,Stone N J,Bailey A L,et al.2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol:A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Circulation.2019;139(25):e1082-e1143. [12] 中国胆固醇教育计划(CCEP)工作委员会.脂蛋白(a)与心血管疾病风险关系及临床管理的专家科学建议｡中国循环杂志.2021; 36(12):1158-1167. [13] Koren M J,Moriarty P M,Baum S J,et al.Preclinical development and phase 1 trial of a novel siRNA targeting lipoprotein(a).Nat Med.2022;28(1):96-103. [14] Kronenberg F,Mora S,Stroes ESG,et al.Lipoprotein(a)in atherosclerotic cardiovascular disease and aortic stenosis:a European Atherosclerosis Society consensus statement.Eur Heart J.2022,43(39):3925-3946. [15] Laiteerapong N,Ham SA,Gao Y,et al.The Legacy Effect in Type 2 Diabetes:Impact of Early Glycemic Control on Future Complications(The Diabetes&Aging Study).Diabetes Care.2019,42(3):416-426. [16] Davies M J,Aroda V R,Collins B S,et al.Management of Hyperglycemia in Type 2 Diabetes,2022.A Consensus Report by the American Diabetes Association(ADA)and the European Association for the Study of Diabetes(EASD).Diabetes Care.2022;45(11):2753-2786. [17] Cosentino F,Grant PJ,Aboyans V,et al.2019 ESC Guidelines on diabetes,pre-diabetes,and cardiovascular diseases developed in collaboration with the EASD.Eur Heart J.2020,41(2):255-323. [18] Visseren FLJ,Mach F,Smulders YM,et al.2021 ESC Guidelines on cardiovascular disease prevention in clinical practice.Eur Heart J. 2021,42(34):3227-3337.

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