糖化血红蛋白与冠状动脉支架术后再狭窄的关系

Relationship between glycated hemoglobin and restenosis after percutaneous coronary intervention procedure

目的应用血管内超声(IVUS)研究糖化血红蛋白(HbAlc)与冠状动脉(冠脉)支架植入术后再狭窄的关系。方法将178例成功接受支架植入术的冠心病患者,根据HbAlc水平分为三组,HbAlc<6.0%组、HbAlc 6.0%～7.0%组、HbAlc>7.0%组。用冠脉造影(CAG)及IVUS随访6～12个月,以CAG直径狭窄率≥50%为支架内再狭窄,用IVUS观察三组冠脉支架术后最小管腔面积、斑块负荷、新生内膜面积,初步探讨HbAlc与再狭窄的关系。结果 178例患者共201处病变,CAG随访示支架内再狭窄30例,再狭窄率14.9%,再狭窄患者的HbAlc水平为6.87%±0.56%,明显高于无再狭窄患者的6.05%±0.47%,两组间差异有统计学意义(P=0.017),其中HbAlc<6.0%组发生再狭窄10例,HbAlc6.0%～7.0%组8例,HbAlc>7.0%组12例,HbAlc>7.0%组再狭窄率为31.6%,明显高于HbAlc 6.0%～7.0%组的13.8%和HbAlc≤6.0%组的9.5%(P<0.01)。相关分析表明HbAlc与新生斑块面积和斑块负荷呈正相关(r分别为0.685和0.617,P<0.01)。结论 HbAlc升高可能与冠脉内膜增生有关,测定HbAlc有助于评估冠脉支架术后再狭窄的风险,控制好HbAlc对预防冠脉支架植入后再狭窄有一定价值。

Objective To investigate the relationship between glycated hemoglobin （HbAlc） level and restenosis after percutaneous coronary stenting by using intravaseular ultrasound （IVUS） technique. Methods Based on the HbAlc level, a total of 178 patients with successful coronary stent placement were divided into 3 groups： HbAlc ≤ 6.0% group, HbAlc 6.0% - 7.0% group and HbAle ≥ 7.0% group. All the patients were followed up for 6 - 12 months, and follow-up examinations with CAG as well as IVUS were conducted. Luminal diameter stenosis ≥ 50% of the original target lesion determined on CAG was used as the criterion of in-stent restenosis （ISR）. After the stent implantation, the minimal lumen area （MLA）, plaque burden（PB） and neo-intimal area（IA） were measured by IVUS. The correlation between HbAlc and ISR was analyzed. Results A total of 201 lesions were detected in 178 patients. Follow- up checkups with CAG showed that restenosis occurred in 30 cases （14.9%）. The HbAlc level of ISR patients was （6.87 ± 0.56）%, while the HbAlc level of non-ISR patients was （6.05＋ 0.47）%, the difference between the above two groups was statistically significant （P = 0.017）. Of the 30 patients developing restenosis, 10 was in HbAlc ≤ 6.0% group, 8 in HbAlc 6.0% - 7.0% group and 12 in HbAlc ≥ 7.0% group. The incidence of restenosis in HbAlc ≥ 7.0% group was 31.6%, which was significantly higher than those of HbAlc 6.0%-7.0% group （13.8%） and HbAlc ≤ 6.0% group （9.5%） （P 〈 0.01）, but no significant difference existed between HbAlc 6.0% - 7.0% group and HbAlc ≤6.0% group. Statistical analysis indicated that HbAlc level had a parallel relationship with both IA and PB （r = 0.685, r = 0.617 respectively, P 〈 0.01）. Conclusion The elevation of HbAlc might be related to the severity of coronary intimal hyperplasia. The determination of HbAlc can help assess the coronary restenosis risk after stent implantation. The effective control of HbAlc level is of certain value in the prevention of ISR. （J Intervent Radiol, 2012, 21： 725-727）