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冠心病伴2型糖尿病患者PCI术后预后分析

张赫男1,李曦铭2,胡越成3,肖建勇4,丛洪良2   

  1. 1. 天津医科大学研究生院
    2. 天津胸科医院
    3. 天津市胸科医院心内4
    4. 天津市胸科医院
  • 收稿日期:2012-07-24 修回日期:2012-10-02 出版日期:2013-01-15 发布日期:2013-01-15
  • 通讯作者: 丛洪良

Outcomes in Patients with Type 2 Diabetes Mellitus Undergoing Percutaneous Coronary Intervention

  • Received:2012-07-24 Revised:2012-10-02 Published:2013-01-15 Online:2013-01-15

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摘要： 【摘要】 目的分析糖尿病(DM)与非糖尿病(NDM)患者成功接受经皮冠状动脉介入治疗(PCI)的预后情况以及2型糖尿病与冠心病预后的相关性。方法将1356例成功接受PCI的冠心病患者依据是否合并2型糖尿病分为DM组292例和NDM组1064例,记录并比较性别、年龄、高血压史、冠心病家族史等一般情况,纤维蛋白原(FIB)、血脂、尿酸等实验室指标及心脏超声指标,依据冠脉造影(CAG)结果的SYNTAX评分将患者分为低分、中分及高分组。比较DM组和NDN组PCI术后12个月内全因死亡、心肌梗死(MI)、靶血管再血管化(TVR)和卒中等主要不良心脑血管事件(MACCE)发生情况。结果 DM组患者FIB、尿酸水平高于NDM组,左心室射血分数低于NDM组,差异均有统计学意义(P<0.01)。DM组SYNTAX积分高于NDM组,在SYNTAX积分低分组、中分组及高分组,糖尿病患者所占比例逐渐升高,差异有统计学意义(P<0.01)。随访期间DM组较NDM组MI、死亡及总MACCE比例均较高,差异均有统计学意义(P<0.01)。DM组与NDM组TVR及卒中比例差异均无统计学意义(P>0.05)。结论冠心病合并2型糖尿病患者PCI术后发生MACCE比例高,在冠心病患者的二级预防中应加强对其血糖、血脂的控制。

关键词: 冠心病, 糖尿病, 2型, 预后, 心肌梗死, 经皮冠状动脉介入治疗, SYNTAX

Abstract: Objective:To compare outcomes of the diabetic and nondiabetic patients with coronary artery disease (CAD) undergoing successful percutaneous coronary intervention (PCI) ,and to investigate the relationship between type 2 diabetes mellitus(T2DM)and outcomes of CAD. Methods: The 1356 patients undergoing successful PCI in our hospital enrolled in the study, were separated into diabetic group (DM, n=292) and nondiabetic group (NDM, n=1064). Using the SYNTAX Score to evaluate the outcomes of CAG, then all the patients were divided into high, medium and low three groups. They had been followed up within 12 months. The clinical data were recorded including age, gender, history of hypertension, family history , the biochemical indicators including blood lipids, fibrinogen, and the echocardiography parameters. The endpoints were main adverse cardiovascular and cerebrovascular events (MACCE), including all-cause deaths, myocardial infarction (MI), target vessel revascularization (TVR) and stroke. All clinical date were statistically analyzed and processed. Results: Compared with the NDM group, the levels of FIB, uric acid in DM group was higher, while the mean left ventricular ejection fraction (LVEF) was lower. The mean SYNTAX score in DM group was higher than that in NDM (P<0.01); from the low group to the high group of SYNTAX score, the proportion of DM were gradually increased (P<0.01). During the follow-up the proportion of MI, death and total MACCE in DM were all significantly higher (all P<0.01). The proportion of TVR in DM was higher, and the proportion of stroke was slightly lower, while there were no difference in two groups (all P>0.05). Conclusions: The CHD patients with T2DM had a higher proportion of MACCE. It suggested that clinicians need to emphasize the control of blood glucose and blood lipid in the secondary prevention of the CHD patients.

Key words: coronary disease diabetes mellitus, type 2prognosis myocardial infarctionpercutaneous coronary intervention SYNTAX, SYNTAX