冠状动脉支架置入后:糖化血红蛋白与再狭窄的关系

Coronary stent restenosis and glycated hemoglobin following coronary stent implantation

背景:众多基础和临床研究表明,多种因素参与了冠状动脉支架内再狭窄的形成,支架内再狭窄除与支架本身有关,吸烟、糖尿病和不稳定心绞痛等更是触发再狭窄的重要预测因素。糖化血红蛋白为糖尿病疗效评定的监测指标以及微血管病变的生化标志。目的:分析冠状动脉支架置入后支架内再狭窄与糖化血红蛋白的关系。方法:将36例成功接受支架置入治疗的冠状动脉粥样硬化性心脏病患者,根据糖化血红蛋白和空腹血糖水平分为3组:糖化血红蛋白与空腹血糖均正常组(n=11)、糖化血红蛋白正常而空腹血糖升高组(n=15)、糖化血红蛋白与空腹血糖均升高组(n=10)。支架置入后患者因胸痛再发或常规行冠脉造影随访,以原靶病变管腔直径狭窄≥50%为支架内再狭窄,对照分析糖化血红蛋白对冠状动脉再狭窄的影响。结果与结论:36例患者中,7例发生冠状动脉内再狭窄,占19%,其中糖化血红蛋白与空腹血糖均正常组中有1例发生再狭窄,糖化血红蛋白正常而空腹血糖升高组中2例发生再狭窄,糖化血红蛋白与空腹血糖均升高组中有4例发生再狭窄。糖化血红蛋白与空腹血糖均升高组中冠状动脉内再狭窄比率明显高于其他两组(P<0.05)。回归分析显示糖化血红蛋白升高是冠状动脉支架置入后再狭窄的重要因素之一,测定糖化血红蛋白可进一步评估冠脉支架置入后再狭窄的风险。

BACKGROUND：Basic and clinical studies have shown that many factors are involved in stent restenosis.In-stent restenosis is correlated with stent,and smoking,diabetes and unstable angina are also important predictors.Glycated hemoglobin is the monitor index of diabetes and biomarker of cardiovascular disease.OBJECTIVE：To evaluate coronary stent plant in-stent restenosis after implantation,and the relationship between glycated hemoglobin.METHODS：A total of 36 patients with successful coronary stenting received atherosclerotic heart disease,were divided into 3 groups according to the level of glycated hemoglobin and fasting blood glucose：normal glycosylated hemoglobin and fasting blood sugar group（n=11）,normal glycosylated hemoglobin and elevated fasting glucose group（n=15）,increased glycosylated hemoglobin and fasting blood glucose group（n=10）.Because of chest pain after stent implantation in patients with recurrent or routine follow-up coronary angiography,the original target lesion≥50%luminal diameter stenosis was in-stent restenosis in the control of glycosylated hemoglobin on coronary artery restenosis.RESULTS AND CONCLUSION：Of 36 patients,7 cases had coronary artery restenosis,accounting for 19%,including 1 in normal glycosylated hemoglobin and fasting blood sugar group,2 in normal glycosylated hemoglobin and elevated fasting glucose group and 4 in increased glycosylated hemoglobin and fasting blood glucose group.Glycosylated hemoglobin and fasting plasma glucose were greater in increased glycosylated hemoglobin and fasting blood glucose group compared with the other two groups（P〈0.05）.The regression analysis showed that glycosylated hemoglobin is one important factor for restenosis following a coronary stent.Glycosylated hemoglobin measurement can further assess the coronary risk of restenosis after stent implantation.