The glycemic fluctuation in peri-percutaneous coronary intervention (PCI) period is closely related to the short-term and long-term prognosis in patients with coronary heart disease (CHD). At present, there are few studies on glycemic fluctuation and its influencing factors in peri- PCI period in these patients.

To explore the characteristics and influencing factors of glycemic fluctuation during peri-PCI period in patients with CHD and type 2 diabetes (T2DM) .

One hundred and fifty-six patients undergoing PCI in the cardiology ward of Jiangsu Provincial People's Hospital from April 2021 to November 2021 were selected. General demographics were collected by general demographics questionnaire. Perioperative glycemic fluctuation was collected by glycemic data questionnaire. The patients were stratified according to the normal reference value range of blood glucose fluctuation evaluation indicators: normal standard deviation of blood glucose level (SDBG) group (<2.0 mmol/L, n=58) and high SDBG group (≥2.0 mmol/L, n=98) by the SDBG level; normal amplitude of postprandial glycemic excursions (PPGE) group (<2.2 mmol/L, n=28) and high PPGE group (≥2.2 mmol/L, n=128) by the PPGE; normal largest amplitude of glycemic excursion (LAGE) group (<4.4 mmol/L, n=39) and high LAGE group (≥4.4 mmol/L, n=117) by the LAGE. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The Hospital Anxiety and Depression Scale (HAD) was used to identify depression and anxiety. The Numeric Rating Scale (NRs) used to assess pain intensity in peri-PCI period. Pearson and Spearman correlation analyses were used to study the correlation of factors related to blood glucose fluctuation during the peri-PCI period. Multiple linear regression analysis was used to explore the factors associated with blood glucose fluctuation during the peri-PCI period.

Normal and high SDBG groups had statistically significant differences in course of diabetes, use of glucose control regimen, mean values of HbA_1c, changes in dieatary intake during perioperative period, operation start time, operation duration, and NRs score; as well as stent/balloon implantation prevalence (P<0.05). HbA_1c in normal SDBG group was lower than that in high SDBG group. There were statistically significant differences in use of glucose control regimen, mean values of BMI and TC, as well as perioperative dietary intake between normal and high PPGE groups (P<0.05). The mean values of BMI and TC of normal PPGE group were higher than those of high PPGE group. There were statistically significant differences in the duration of diabetes, use of glucose control regimen, mean values of TC, HbA_1c and NRS score between normal and high LAGE groups (P<0.05). The normal LAGE group had higher TC and lower HbA_1c than high LAGE group. The results of repeated measures ANOVA showed that the mean values of SDBG, PPGE and LAGE on the day before PCI, the day of PCI and the day after PCI were significantly different (P<0.05). Correlation analysis showed that during the peri-PCI period, SDBG was positively correlated with age, NRs score and PSQI score (r=0.216, 0.188, 0.295, P<0.05). PPGE was positively correlated with age, duration of diabetes (r_s=0.179, P<0.05) and NRs score (r_s=0.165, P<0.05), and negatively correlated with BMI and TG (r_s=-0.254, -0.196, P<0.05). LAGE was positively correlated with the duration of diabetes, HbA_1c and HAD score (r_s=0.355, 0.171, 0.158, P<0.05). Multiple linear regression analysis showed that age; diet, PSQI score, and the time from the final meal before PCI to the start of PCI were independent factors influencing SDBG, with an explanatory degree of 19.3% (P<0.05). Education level, BMI, glucose control regimen, the time from the end of PCI to the first meal after PCI, and the time from the final meal before PCI to the start of PCI were independent factors influencing PPGE, with an explanation degree of 21.3% (P<0.05). The duration of diabetes, systolic blood pressure, PSQI score, location of domicile, perioperative exercise time, NRs score, the time from the end of PCI to the first meal after PCI; and time of surgery initiation were independent factors influencing LAGE, with an explanation degree of 47.8% (P<0.05) .

The influencing factors of blood glucose fluctuation during the peri-PCI period in patients with CHD and T2DM may include age, diabetes course, systolic blood pressure, registered permanent residence, education level, BMI, diet, perioperative exercise time, sleep quality, pain level, the time from the end of PCI to the first meal after PCI; the time from the final meal before PCI to the start of PCI, time of surgery initiation, and glycemic control plan. Based on these factors, personalized plans can be designed to control blood sugar fluctuations to improve the prognosis.

冠心病患者经皮冠状动脉介入治疗（PCI）围术期的血糖波动与其近、远期预后密切相关。目前，关于患者PCI围术期血糖变化规律及其影响因素的研究较少。

探究冠心病合并2型糖尿病患者PCI围术期血糖波动的特点及影响因素。

选取2021年4—11月在江苏省人民医院心内科病房进行PCI的156例患者为研究对象，分别按照血糖波动评价指标的参考值对患者进行分组：按照血糖水平标准差（SDBG）将患者分为SDBG正常组（<2.0 mmol/L，n=58）和SDBG高波动组（≥2.0 mmol/L，n=98）；按照餐后血糖波动幅度（PPGE）将患者分为PPGE正常组（<2.2 mmol/L，n=28）和PPGE高波动组（≥2.2 mmol/L，n=128）；按照最大血糖波动幅度（LAGE）将患者分为LAGE正常组（<4.4 mmol/L，n=39）和LAGE高波动组（≥4.4 mmol/L，n=117）。采用一般资料调查表、血糖相关资料调查表收集患者一般资料和围术期血糖波动情况；分别采用匹兹堡睡眠质量指数量表（PSQI）、医院焦虑抑郁自评量表（HAD）、数字疼痛强度评估量表（NRs）评估患者睡眠质量、焦虑抑郁情况及围术期疼痛状况。采用Pearson相关分析和Spearman秩相关分析探讨患者PCI围术期与血糖波动相关的因素，采用多元线性回归分析探讨患者PCI围术期血糖波动的影响因素。

SDBG正常组和SDBG高波动组患者糖尿病病程、控糖方案、糖化血红蛋白（HbA_1c）、围术期饮食量变化、手术开始时间段、手术持续时长、支架/球囊植入情况、NRs评分比较，差异有统计学意义（P<0.05），SDBG正常组HbA_1c低于SDBG高波动组；PPGE正常组和PPGE高波动组患者控糖方案、体质指数（BMI）、总胆固醇（TC）、围术期饮食量变化比较，差异有统计学意义（P<0.05），PPGE正常组BMI、TC高于PPGE高波动组；LAGE正常组和LAGE高波动组患者糖尿病病程、控糖方案、TC、HbA_1c、NRs评分比较，差异有统计学意义（P<0.05），LAGE正常组TC高于LAGE高波动组，HbA_1c低于LAGE高波动组。重复测量方差分析结果显示PCI患者围术期3 d的SDBG、PPGE、LAGE差异均有统计学意义（P<0.05）。相关性分析结果显示，患者PCI围术期SDBG与年龄、NRs评分、PSQI评分呈正相关（r=0.216、0.188、0.295，P<0.05）；PPGE与年龄、糖尿病病程、NRs评分呈正相关（r_s=0.179、0.165，P<0.05），与BMI、三酰甘油（TG）呈负相关（r_s=-0.254、-0.196，P<0.05）；LAGE与糖尿病病程、HbA_1c、HAD评分呈正相关（r_s=0.355、0.171、0.158，P<0.05）。多元线性回归分析结果显示，年龄、围术期饮食量变化、PSQI评分、术前进食至手术开始时间是PCI患者SDBG的独立影响因素，解释度为19.3%（P<0.05）；受教育程度、BMI、控糖方案、手术结束至进餐时间、术前进食至手术开始时间是PCI患者PPGE的独立影响因素，解释度为21.3%（P<0.05）；糖尿病病程、收缩压、PSQI评分、户籍地、围术期运动时间、NRs评分、手术结束至进餐时间、手术开始时间段是PCI患者LAGE的独立影响因素，解释度为47.8%（P<0.05）。

冠心病合并2型糖尿病患者PCI围术期血糖波动的影响因素包括年龄、糖尿病病程、收缩压、户籍地、受教育程度、BMI、饮食、围术期运动时间、睡眠质量、疼痛、手术结束至进餐时间、术前进食至手术开始时间、手术开始时间段、控糖方案，临床医护人员可考虑这些因素为围术期患者制订个性化血糖管理方案，降低血糖波动，以改善患者预后。