【摘要】 目的　探讨老年冠心病合并糖尿病患者冠状动脉病变特点及其相关危险因素。　方法　根据 1997年WHO糖尿病诊断标准 ,对 133例冠心病 (CHD)患者行口服 75g葡萄糖耐量试验 ,其中冠心病合并糖尿病 (CHD +DM)组 6 5例 ,单纯CHD组 6 8例 ,133例患者均行冠状动脉造影 (CAG) ,检测血糖、胰岛素、血脂、血压、血尿素氮 (BUN)、血肌酐 (Cr)。冠状动脉病变程度应用CAG分析 ,冠状动脉狭窄程度根据美国心脏协会 (AHA) 1975年分类标准评价 ,冠状动脉病变的危险因素应用多元逐步直线回归分析。　结果　CHD +DM组多支冠状动脉病变的发生率高于CHD组 (75 4 %与 38 2 % ,P<0 0 5 ) ;冠状动脉狭窄 (8 6± 3 8与 6 5± 3 9,P <0 0 5 )及钙化程度 (6 6± 6 1与 3 9± 4 1,P <0 0 5 )高于CHD组 ;冠状动脉远端病变发生率高于CHD组 (41 2 %与 13 1% ,P <0 0 5 ) ;血脂、胰岛素、血压与冠状动脉粥样硬化程度明显正相关 (P <0 0 0 1)。　结论　老年CHD +DM患者多支冠状动脉病变的发生率增高 ,病变多呈弥漫性狭窄 ,远端血管病变发生率高。提示糖尿病、高脂血症、高血压是发生冠状动脉粥样硬化的独立危险因素更多还原

【Abstract】 Objective To study the characteristics and the related risk factors of coronary artery changes in the elderly patients of coronary heart disease complicated with diabetes mellitus. Methods According to WHO diagnostic standards of diabetes, coronary heart disease(CHD) complicated with diabetes mellitus(65 patients) was indicated as CHD+DM group, and the coronary heart disease without diabetes(68 patients) was indicated as CHD group. All patients were examined by coronary angiographic semiquantitative(CAG), and blood pressure, oral glucose tolerance test, level of blood sugar, insulin, lipid, BUN and Cr were measured. The coronary artery changes were analysed by CAG, and the severity of coronary artery stenosis were evaluated by AHA standards. The related risk factors in coronary artery disease were analysed by pluralism straight line statistics. Results The coronary multivessel changes(75 4% vs 38 2%, P <0 05), the severity of coronary artery stenosis(8 6±3 8 vs 6 5±3 9, P <0 05) and the calcification (6 6±6 1 vs 3 9±4 1, P <0 05) were significantly increased in CHD+DM group than in CHD group. Distal coronary changes were more frequently seen in the CHD+DM group than in CHD group. The atherosclerotic changes of the coronary artery was significantly correlated with the level of serum lipid and insulin and blood pressure. Conclusions The occurrence of coronary multivessel changes and distal coronary changes were more frequent in the CHD+DM group than in the CHD group, and most of them showed coronary artery diffusing stenosis. These results suggest that diabetes mellitus, hyperlipemia and hypertension are all independent risk factors for the occurrence of coronary artery disease.更多还原