糖调节受损对冠状动脉介入治疗患者预后的影响

The influence of impaired glucose regulation on coronary heart disease patients underwent PCI

目的研究冠心病(包括不稳定性心绞痛、稳定性心绞痛、急性ST段抬高型心肌梗死、急性非ST段抬高型心肌梗死患者)合并糖调节受损及糖尿病患者,在行冠状动脉介入(PCI)治疗后6个月发生的心血管事件。方法将2008年9月—2010年9月行PCI治疗的患者206例,随机分成4组,糖尿病组(A组)70例、空腹血糖受损组(B组)36例、糖耐量减低组(C组)35例、非糖调节受损组或正常血糖组(D组)65例。对4组冠状动脉造影结果进行比较;部分患者复查冠状动脉造影等,对近期预后进行评估。结果冠状动脉造影结果比较,A、B、C组冠状动脉三支病变、左主干病变、C型病变均多于D组(P<0.05);心功能方面,6个月时心脏超声测EF值,结果示:A、B、C、D组之间比较无差异(P>0.05)。对有心绞痛症状的患者进行运动试验初步筛选,A、B、C组运动试验结果阳性发生率与D组比较有差异(P<0.05),而A、B、C组之间比较无差异(P>0.05)。4组患者中对运动试验阳性的患者复查冠状动脉造影,A、B、C组支架内再狭窄发生率高于D组(P<0.05);A、B、C组新出现其他血管病变的发生率高于D组(P<0.05)。A、B、C组HbA_(1c)高于D组,差异有统计学意义(P<0.05)。结论糖调节受损与2型糖尿病有类似血管损害,早期发现血糖异常、尽早干预血糖对PCI患者预后非常重要。

Objective To study the incidence of 6 months cardiovascular events in coronary heart disease patients （including unstable angina, stable angina, acute ST segment elevation myocardial infarction, acute non-ST segment elevation myocardial infarction） with impaired glucose regulation, which underwent percutaneous coronary intervention （PCI）. Methods From September 2008 to September 2010,206 patients underwent PCI were randomly divided into four groups, the diabetic group （ A group, n = 70）, impaired fasting glucose group （ B group, n = 36 ）, impaired glucose tolerance group （ C group, n = 35 ）, and non-impaired glucose regulation group or normal blood glucose group （D group, n = 65 ）. The coronary angio- graphic were re-performed and compared, and short term prognosis was evaluated. Results The re-performed coronary angiog- raphy displayed that the incidences of the three branches lesion, left main stem lesion, C-type lesions were more in group A , B, C than those of in the D group （ P 〈 0.05 ）. The cardiac ultrasound at 6 months displayed that the EF values has no difference among four groups （ P 〉 0.05 ）. Symptoms of patients with angina initial screening exercise test results are shown ： A, B, C group exercise test results positive difference compared with the D group （ P 〈 0.05 ） , while there was no difference among the A, B, C groups（ P 〉 0.05 ）. Four groups of patients with positive exercise test in patients with coronary angiogra- phy reviewed that the rate of re-stenosis rate was higher in A, B, C group than that in the D group （ P 〈 0.05 ）, also the inci- dence of new cardiovascular events （ P 〈 0.05 ）. Biochemical indexes of HbAlo in A, B,C groups were higher than that of in the D group （ P 〈 0.05 ）. Conclusion Impaired glucose regulation and type 2 diabetes have similar effect on vascular dama- ge, and it was important to detect blood sugar abnormality as well as early intervention.