冠状动脉支架内再狭窄与糖尿病性视网膜病变的相关性分析

Relationship between stent restenosis and retinopathy in patients with type 2 diabetes mellitus

目的探讨冠状动脉支架内再狭窄与糖尿病性视网膜病变的相关性。方法选取2010年6月至2014年6月新疆生产建设兵团第六师医院心内科2型糖尿病住院患者408例，所有患者冠状动脉介入治疗置入支架及冠状动脉造影复查资料齐全，将所有患者分为冠状动脉支架内再狭窄组（123例）和无冠状动脉支架内再狭窄组（285例）。所有患者根据糖尿病性视网膜病变国际临床分级标准分为无糖尿病性视网膜病变组（279例）、背景型糖尿病性视网膜病变组（81例）、增殖期糖尿病性视网膜病变组（48例）。分析2型糖尿病患者冠状动脉支架内再狭窄、糖尿病性视网膜病变的危险因素及两者的相关性。结果与无冠状动脉支架内再狭窄组比较，冠状动脉支架内再狭窄组糖尿病病程长、糖化血红蛋白高[（149±19）个月比（117±17）个月、（9．7±2．2）％比（8．4±2．1）％]，差异均有统计学意义（均P〈0．05）。Logistic回归分析表明，糖尿病病程（≥10年）、糖化血红蛋白（97．5％）、吸烟、分叉病变、钙化病变、重叠置入支架是冠状动脉支架内再狭窄的独立危险因素。无糖尿病性视网膜病变组、背景型糖尿病性视网膜病变组、增殖期糖尿病性视网膜病变组患者吸烟、糖尿病病程、糖化血红蛋白、冠状动脉内再狭窄比例比较[30．5％（85／279）比45．7％（37／81）、50．0％（24／48），（149±109）个月比（189±111）个月、（219±122）个月，（8．1±4．1）％比（8．5±2．7）％、（9．2±3．6）％，22．2％（62／279）比42．0％（34／81）、56．2％（27／48）]，差异均有统计学意义（均P〈0．05）。吸烟、糖尿病病程（≥10年）、糖化血红蛋白是糖尿病性视网膜病变的独立危险因素。结论冠状动脉支架内再狭窄比例随着糖尿病性视网膜病变的加重而逐渐增高。

Objective To explore the relationship between stent restenosis and retinopathy in patients with type 2 diabetes mellitus （T2DM）. Methods A total of 408 patients with T2DM who underwent coronary stent implantation from June 2010 to June 2014 were enrolled. The patients were divided into two groups, restenosis group （123 cases） and non-restenosis （285 cases）, and three groups according to retinopathy stages, non-diabetic reti-nopathy group （279 cases） , background phase group （ 81 cases） , proliferative phase group （48 cases）. The risk factors of stent restenosis and diabetic retinopathy were analyzed, the correlation between stent restenosis and diabetic retinopathy was assessed. Results Compared with those in non-restenosis group, the duration of T2DM and hemoglobin A1 c （ HbA1c） in restenosis group were significantly longer and higher [ （ 117 ± 17 ） months vs （ 149 ±19） months, （ 8. 4± 2. 1 ） % vs （ 9.7 ±2.2 ） % ] （ P 〈 0. 05 ）. Logistic stepwise multiple regression analysis showed that the independent risk factors for stent restenosis included duration of T2DM ≥ 10 years, HbAlc ≥7.5% , smoking, bifurcation lesion, calcified lesion, overlapping stent implantation. The proportion of smoking, duration of T2DM, HbAlc and stent restenosis ratio among non-diabetic retinopathy group, background phase group and proliferative phase group were significantly different [30. 5% （85/279） vs 45.7% （37/81） , 50. 0% （24/48） , （149±109） months vs （189±111） months, （219±122） months, （8.1 ±4. 1）% vs （8.5 ±2.7 ） %, （9.2 ±3.6） %, 22.2% （62/279） vs 42. 0% （34/81）, 56.2% （27/48） ] （ P 〈 0. 05）. The independent risk factors for diabetic retinopathy included smoking, duration of T2DM≥ 10 years and HbAle. Conclusion The proportion of stent restenosis increased along with severity of diabetic retinopathy.