吸烟、HbA1c、PLT、GLB、CK-MB与2型糖尿病合并冠心病冠脉狭窄的相关性研究

A Study on the Correlation between Smoking, HbA1c, PLT, GLB, CK-MB and Coronary Stenosis in Type 2 Diabetes Mellitus Patients with Coronary Heart Disease

摘要: 目的：早期识别2型糖尿病合并冠心病患者冠状动脉狭窄程度的潜在影响因素，以优化预后治疗策略。方法：回顾性分析2023年1月~2024年1月于安徽医科大学第一附属医院心血管内科行冠状动脉造影的130例2型糖尿病(T2DM)并发冠心病(CHD)患者的临床资料。为了更准确地评估冠脉病变的严重程度，我们根据Gensini评分将入选患者分为两组，低分组(Gensini ≤ 20, n = 64)和高分组(Gensini > 20, n = 66)。通过比较两组患者一般资料及实验室相关指标，探究T2DM合并CHD患者冠脉狭窄程度的影响因素。结果：高分组患者吸烟占比、糖化血红蛋白(HbAlc)、中性粒细胞数(NE)、单核细胞数(MO)、血小板计数(PLT)、血小板压积(PCT)、总蛋白(TP)、球蛋白(GLB)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、脂蛋白a (Lpa)水平、SII、SIRI指数均高于低分组，且差异均具有统计学意义(P < 0.05)。而低分组的白球比值(AGR)较高(P < 0.05)。值得注意的是，进一步logistic多因素回归分析显示，吸烟及HbA1c、PLT、GLB、CK-MB等指标是冠脉狭窄的独立危险因素(均P < 0.05)。结论：T2DM合并CHD患者冠脉狭窄程度随着吸烟及HbAlc、PLT、GLB、CK-MB水平的升高而加剧，积极戒烟并定期监测上述临床指标，有利于延缓冠脉病变进展。

Abstract: Objective: To identify the potential factors of coronary artery stenosis degree in patients with type 2 diabetes mellitus and coronary heart disease early, so as to optimize the prognosis treatment strategies. Methods: A retrospective analysis was conducted on the clinical data of 130 patients with type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD) who underwent coronary angiography at the Department of Cardiology, First Affiliated Hospital of Anhui Medical University from January 2023 to January 2024. To more accurately assess the severity of coronary artery lesions, we divided the enrolled patients into two groups based on the Gensini score: the low-score group (Gensini ≤ 20, n = 64) and the high-score group (Gensini > 20, n = 66). By comparing baseline and laboratory indices between the two groups, we identified factors associated with the severity of coronary stenosis in T2DM-CHD patients. Results: Patients in the high Gensini score group had higher proportions of smokers and higher levels of HbA1c, NE, MO, PLT, PCT, TP, GLB, CK, CK-MB, Lpa, SII, and SIRI compared with those in the low Gensini score group, with statistical significance (P < 0.05). Conversely, the white-to-red ratio (AGR) in the low-score group was higher (P < 0.05). It is worth noting that further logistic multivariate regression analysis revealed that smoking, as well as blood indicators such as HbA1c, PLT, GLB, and CK-MB, each independently predicted coronary stenosis (all P < 0.05). Conclusion: In patients with T2DM and CHD, the degree of coronary artery stenosis worsens with the increase in smoking and blood indicators such as HbAlc, PLT, GLB, and CK-MB. Actively quitting smoking and regularly monitoring these clinical indicators is beneficial for delaying the progression of coronary artery disease.