糖尿病急性心肌梗死患者的临床特点及随访研究

Clinical features and follow-up study on diabetic patients with acute myocardial infarction

目的:探讨糖尿病急性心肌梗死患者的临床特点,分析植入药物洗脱支架后1年的随访情况。方法:将入选的350名急性心肌梗死患者分为两组,其中糖尿病组107人,非糖尿病组243人。所有患者均植入药物洗脱支架,对两组患者的临床危险因素及1年随访结果进行分析。结果:糖尿病组比非糖尿病组患者年龄大[(65.50±12.73)vs(60.80±14.38)岁,P=0.004]、男性比例少(58.5%vs 70.1%,P=0.012)、吸烟比例高(38.3%vs 24.3%,P=0.007),更易合并高血压病(84.1%vs 76.1%,P<0.001)、高脂血症(89.7%vs 79.0%,P=0.016)、慢性肾功能不全(24.3%vs 8.2%,P<0.001)等情况。糖尿病组比非糖尿病组3支病变比例高(41.1%vs 29.6%,P=0.035)、单支病变比例低(27.1%vs 44.4%,P=0.002)。糖尿病组主要心脏不良事件总的发生率高于非糖尿病组(19.6%vs 9.5%,P=0.008),其中全因性死亡是主导事件(13.1%vs 4.5%,P=0.004)。两组患者靶病变血运重建(4.7%vs 4.5%,P=0.952)、靶血管血运重建(12.1%vs 7.8%,P=0.195)、再次心肌梗死(1.9%vs 0.4%,P=0.173)、支架内再狭窄(2.8%vs 2.9%,P=0.968)、支架内血栓形成(1.9%vs 1.6%,P=0.882)的发生率没有显著差异。结论:糖尿病急性心肌梗死患者比非糖尿病急性心肌梗死患者平均年龄大,且女性、吸烟、高血压、高血脂、肾功能不全、3支病变的比例均高于后者,药物洗脱支架没有增加糖尿病急性心肌梗死患者再次心肌梗死、血运重建、支架内再狭窄、支架内血栓形成的发生率,但其主要心脏不良事件总的发生率比非糖尿病急性心肌梗死患者高,且主导事件是全因性死亡。

Objective：To evaluate the clinical characteristics of diabetic patients with acute myocardial infarction and the incidence of MACE after being treated with drug-eluting stents .Methods：350 patients who presented with acute myocardial infarction and were treated with drug-eluting stents were classified into 2 groups according to the＆amp;nbsp;presence or absence of DM .The clinical characteristics and one-year follow-up results in the two groups were analyzed.Results：The patients with DM were older than the patients without DM [（65.50 ±12.73）vs（60.80 ± 14.38）,P=0.004].The ratio of male patients was lower in the DM group （58.5%vs 70.1%,P=0.012）and the ratio of smoking （ 38.3% vs 24.3%, P =0.007 ） , hypertension （ 84.1% vs 76.1%, P 〈0.001 ） , hyperlipidemia （89.7%vs 79.0%,P=0.016）,chronic renal insufficiency （24.3% vs 8.2%,P〈0.001） was higher in the DM group.The incidence of multi-vessel disease was higher in the DM group （41.1%vs 29.6%,P=0.035） ,but the incidence of one-vessel disease was higher in the non-DM group （27.1%vs 44.4%,P=0.002）.The incidence of composite MACE of one year was higher in the DM group （19.6%vs 9.5%,P=0.008）.The incidence of death of one year was higher in the DM group （13.1% vs 4.5%,P=0.004）.Conclusion： The DM patients with AMI is older and have higher ratio of female gender ,smoking,hypertension,hyperlipidemia and chronic renal insufficiency than the non-DM patients with AMI;Compared to the non-DM patients with AMI ,the DM patients with AMI show a preponderance of multi-vessel disease , the drug-eluting stent does not increase the incidence of myocardial infarction,target lesion revascularization , restenosis and stent thrombosis in the DM group .The incidence of composite MACE of one year is higher in the DM group , the all-case death are the dominant event .