糖尿病对直接冠状动脉介入治疗的急性心肌梗死患者预后的影响研究

Impact of Diabetes Mellitus on Prognosis of AMI Patients Undergoing PCI

目的观察糖尿病(DM)对接受直接经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者预后的影响。方法回顾性分析因AMI于2010—2011年在我院住院行直接PCI的患者794例,根据是否患有糖尿病分为DM组(175例)与对照组(619例)。通过观察两组临床特点、造影结果、术后心肌梗死溶栓试验(TIMI)血流及住院期间病死率评价预后。结果与对照组相比,DM组患者年龄、高血压史、发病至就诊时间、术前TIMI血流0级、病变血管数、梗死相关动脉(IRA)开通时间、术后无复流或慢血流发生比例、住院期间病死率均增高,而男性比例、吸烟、左室射血分数、术后TIMI血流3级比例、ST段回落率均降低,两组间差异有统计学意义(均P<0.05);Logis-tic回归分析显示:DM与直接PCI术后住院期间病死率有回归关系〔OR=2.034,95%CI(0.976,3.988),P=0.031〕。结论 DM患者直接PCI术后心功能及组织灌注差,住院期间病死率高,应重视这些临床特点、加强监护、积极干预。

Objective To investigate the impact of diabetes mellitus （DM） on prognosis of patients with acute myo- cardial infarction （AMI） who underwent primary percutaneous coronary intervention （PCI）. Methods The data of 794 AMI patients undergoing PCI from 2010 to 2011 were analyzed retrospectively. The patients were divided into DM group （n = 175 ）, the others into control group （n = 619）. The clinical features, angiographic results, post - operative TIMI flow and hospital mortality were observed to evaluate prognosis. Results As compared with control group, age, hypertension, onset to treatment time, pre - operative TIMI flow 0 degree, number of diseased vessels, IRA - time, post - operative non - occurrence rate of re- flow or slow flow, hospital mortality increased, while the proportion of males, smoking, left ventricular ejection fraction, rate of post - operative TIMI flow 3 degree, ST segment drop rate decreased, the difference was significant （ P 〈 0. 05 ）. Logistic re- gression analysis showed that DM was an independent risk factor influencing hospital mortality after PCI [ OR = 2. 034, 95% CI （0. 976, 3.988）, P = 0. 0311. Conclusion Post - PCI heart function and tissue perfusion are poor and hospital mortality is high in DM patients. Attention should be paid to these clinical features, and cares and intervention be strengthened.