目的 探讨高龄非糖尿病患者糖化血红蛋白(HbA1c)与冠状动脉病变严重程度的相关性.方法 连续入选2016年1月至2017年7月于首都医科大学附属北京安贞医院经冠状动脉造影诊断冠状动脉粥样硬化性心脏病的高龄非糖尿病患者(≥80岁)共150例,根据纳入及排除标准,最终纳入112例.将所有患者按照冠状动脉病变严重程度分为单支病变组(33例)、双支病变组(43例)、三支病变或左主干病变组(36例).按照HbA1c水平分为Q1组(HbA1c≤5.6％,35例)、Q2组(5.7％≤HbA1c≤5.9％,34例)、Q3组(6.0％≤HbA1c≤6.2％,25例)、Q4组(6.3％≤HbA1 c≤6.5％,18例).比较不同冠状动脉病变严重程度患者HbA1 c水平,采用Logistic回归分析HbA1c水平与冠状动脉病变严重程度的关系,进一步通过受试者工作特征曲线分析HbA1 c预测冠状动脉多支病变的效果.结果 三支病变或左主干病变组患者HbA1c水平明显高于单支病变组和双支病变组[(6.0±0.4)％比(5.6±0.3)％、(5.8±0.4)％],差异均有统计学意义(均P ＜0.05).多因素Logistic回归分析显示,在调整传统危险因素和其他混杂因素后,与Q4组比较,Q1组与Q2组发生三支病变及左主干病变的风险相对较小(比值比=0.036,95％置信区间:0.003 ～0.399,P=0.007;比值比=0.050,95％置信区问:0.005 ～0.497,P=0.011).HbA1c水平可较好地预测冠状动脉多支病变(双支病变组及三支病变或左主干病变组)(曲线下面积=0.758,95％置信区间:0.668 ～ 0.848,P＜0.001),且以HbA1c为5.85％预测冠状动脉多支病变效果最佳,敏感度及特异度分别为0.633、0.879.结论 高龄非糖尿病患者HbA1c与冠状动脉病变严重程度密切相关,有效的血糖管理可能会降低冠状动脉血管病变的复杂程度.%Objective To investigate the relation between glycosylated hemoglobin(HbA1c) and severity of coronary atherosclerotic heart disease(CHD) in elderly non-diabetic patients.Methods A total of 150 elderly non-diabetic patients (≥ 80 years old) who were diagnosed of CHD by coronary angiography were consecutively enrolled from January 2016 to July 2017 in Beijing Anzhen Hospital,Capital Medical University;112 cases meeting the inclusion criteria were divided into 3 groups according to severity of CHD:single vessel disease group (group A,n =33),double vessels disease group (group B,n =43) and three vessels disease/left main disease group(group C,n =36).According to HbA1c level,the patients were divided into Q 1 group(HbA1 c ≤5.6％,n=35),Q2 group(5.7％ ≤HbA1c≤5.9％,n =34),Q3 group(6.0％ ≤HbA1c≤6.2％,n =25) andQ4 group(6.3％ ≤HbA1c≤6.5％,n=18).Relation between HbA1c level and severity of CHD was analyzed by logistic regression;the predictive value of HbA1c for coronary multivessel disease was analyzed by the receiver operating characteristic (ROC) curve.Results HbA1 c level in group C was significantly higher than that in group A and group B [(6.0 ± 0.4) ％ vs (5.6 ± 0.3) ％,(5.8 ± 0.4) ％] (P ＜ 0.05).Logistic regression analysis showed that Q1 group and Q2 group had less risk of three vessel disease or left main disease compared to group Q4 (odds ratio =0.036,95％ confidence interval:0.003-0.399,P =0.007;odds ratio =0.050,95％ confidence interval:0.005-0.497,P =0.011).ROC curve analysis showed that HbA1c had a good value in prediction of coronary multivessel disease(group B and group C);the area under curve was 0.758 (95％ confidence interval:0.668-0.848,P ＜ 0.001);HbA1 c =5.85％ showed the best predictive value;the sensitivity was 0.633 and the specificity was 0.879.Conclusion There is a close relation between HbA1c level and severity of CHD in elderly non-diabetic patients.
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