糖尿病与非糖尿病冠心病患者冠脉弥漫长病变经介入治疗的预后观察

Diabetes and non-diabetic patients with coronary heart disease diffuse long lesions after coronary interventional therapy prognosis

目的:以非糖尿病冠心病患者做对照组,评价冠心病合并糖尿病冠脉弥漫长病变患者经药物支架治疗1年后的预后。方法:共入选238例经雷帕霉素药物涂层支架治疗的患者,糖尿病组77例,非糖尿病组161例,均为冠脉弥漫长病变(病变长度大于20mm)。详细记录所有入选患者的姓名,性别,年龄,联系电话,入院时血压,血脂(LDL-C),是否吸烟,心脏彩超的E值,A值及左室射血分数(LVEF),冠脉病变长度、部位、平均支架数、支架管径、支架长度。通过电话、门诊随访记录1年后患者心脏不良事件(MACE)的发生率,包括再发心绞痛,心肌梗死,冠脉搭桥及心源性死亡。门诊复查心脏超声记录二尖瓣血流频谱舒张早期速度E和舒张晚期速度A,以及左心室射血分数(LVEF),以E/A作为评价左心室舒张功能指标,并进行统计学处理。结果:糖尿病组与非糖尿病组间的临床基本资料除LDL-C糖尿病组高于非糖尿病组外,其余均无统计学差异。除糖尿病组1年后再发心绞痛发生率高于非糖尿病组外(P=0.029),差异有统计学意义,其他1年后再发心肌梗死(P=0.732),冠脉搭桥手术(CABG)(P=0.400),心源性死亡的发生率(P=0.448),左心室的功能(P=0.236)两组间差异均无统计学意义。两组患者治疗1年后EF值较1年前有明显的提高,糖尿病组治疗前后分别为52.74±11.70vs66.67±2.38;非糖尿病组分别为55.13±9.52vs66.12±3.33;E/A比值也由1年前的<1改善到>1,糖尿病组治疗前为0.70±0.19/0.85±0.21,治疗后为0.85±0.14/0.72±0.09;非糖尿病组治疗前为0.68±0.19/0.83±0.18,治疗后为0.85±0.18/0.73±0.09。结论:糖尿病与非糖尿病冠心病患者冠脉弥漫长病变经介入治疗1年后,心肌梗死、CABG、心源性死亡发生率和左心室功能相当;而糖尿病组再发心绞痛的发生率高于非糖尿病组。糖尿病与非糖尿病冠心病患者冠脉弥漫长病变经雷帕霉素药物涂层支架治疗可以明显改善1年的预后。

Objective： To observe the prognosis of diabetes and non-diabetic patients with coronary heart disease diffuse long lesions after sirolimus-eluting stents one year. Methods： A total of 238 cases with coronary heart disease diffuse long lesions after sirolimus-eluting stents, including diabetic group of 77cases; non-diabetic group of 161 cases, are filled with long coronary lesions （lesion length greater than 20 mm and above）. Detailed record of all the selected patient＇s name , sex, age, telephone number, admission blood pressure, blood lipids （LDL-C）, smoking, the heart of the E value, A values and left ventricular ejection fraction （LVEF） of ultrasound, coronary artery lesion length, the average number of stents, stent diameter, stent length. By phone, out-patient follow-up records of major adverse cardiac events（MACE） in patients after one year, including recurrent angina, myocardial infarction, coronary artery bypass grafting（CABG） and cardiac death. Review out-patient cardiac ultrasound recording of early diastolic mitral flow velocity E and late diastolic velocity A , and left ventricular ejection fraction （LVEF）. All data used SPSS16.0 package deal , to P0.05 indicated statistical significance. Results： The basic information of clinical from diabetic group and non-diabetic groups has not statistical difference , except LDL-C diabetes group was higher than non-diabetic group. In addition to the incidence of angina diabetic group is higherthan non-diabetic group （P=0.029）, the others have not statistical difference between the two groups, myocardial infarction （P=0.732）, coronary artery by- pass graft surgery （CABG ） （P=0.400）, the incidence of cardiac death （P=0.448）, left ventricular function （P=0.236）. After one year of therapy, the LVEF val-ues is higher than a year ago ,it has significantly improved, and diabetes before and after treatment were 52.74±11.70 vs 66.67±2.38; non-diabetic group were 55.13±9.52 vs 66.12±3.33; E / A ratio is also by less than one year ago, improved to greater than 1, diabetic group before treatment 0.70±0.19/0.85±0.21, after treatment 0.85±0.14/0.72±0.09; non-diabetic group before treatment 0.68±0.19/0.83±0.18, after treatment 0.85±0.18/0.73±0.09. Conclusion： Diabetes and non-diabet- ic patients with coronary diffuse long lesions after sirolimus—eluting stents one year, myocardial infarction, CABG, the incidence of cardiac death and left ventricular function are no difference, the incidence of angina diabetic group is higher than non-diabetic group. Diabetes and non-diabetic patients with coronary heart disease diffuse long coronary lesions after sirolimus—eluting stents can significantly improve the prognosis of one year.