对比分析介入疗法及药物疗法对于冠状动脉临界狭窄病变的长期疗效

Comparative analysis of the long-term effects of PCI therapy and MT therapy on coronary intermediate lesion

目的：比较介入治疗（ PCI）及药物治疗（ MT）对于冠状动脉临界狭窄病变（ CIL）的长期疗效。方法从2011年2月至2012年3月，郑州大学第一附属医院共有122例不稳定型心绞痛（ UA）或非ST段抬高型急性心肌梗死（NSTEMI）患者经冠状动脉造影显示为CIL。以数字法随机分成PCI组（61例）和MT组（61例）。PCI组行PCI疗法治疗，而MT组则实施MT疗法治疗。对比两组长期疗效以及缺血事件情况。结果 MT组死亡1例， BMI达标率为43.75%（21/48），血糖达标率为61.54%（24/39），血脂达标率为69.05%（29/42），血压达标率为88.37%（38/43）；PCI组死亡2例，BMI达标率为45.24%（19/42），血糖达标率为67.57%（25/37），血脂达标率为75.61%（31/41），血压达标率为92.31%（36/39）。两组相比，差异均无统计学意义（P均﹥0.05）。MT组主要不良心血管事件（MACE）发生率为22.95%（14/61），显著低于PCI组（40.98%，25/61）；而稳定型心绞痛（SA）的发生率为52.46%（32/61），显著高于PCI组（34.43%，21/61），差异均有统计学意义（P均﹤0.05）。MT组和PCI组在心肌梗死（ MI）、心源型死亡（ CD）、靶血管的再成形术（ TLR）及UA等事件方面比较，差异均无统计学意义（ P均﹥0.05）。结论临床治疗CIL患者时，若狭窄不严重，则不必急于行PCI疗法，盲目实施反而会增加TLR风险，从而进一步增加MACE风险。而MT疗法则不仅在一定程度上减少了患者治疗费用，并且预后良好，整体效果更佳，值得临床推荐。

Objective To compare the long-term effects of PCI therapy and MT therapy on coronary intermediate lesion（CIL）. Methods From February 2011 to March 2012,a total of 122 patients with unstable angina（ UA）or non-ST-elevation myocardial infarction（ NSTMI）showed CIL by coronary angiography in the first affiliated hospital of Zhengzhou university. They were randomly divided into PCI group（61 cases）and MT group（61 cases）. Patients in PCI group were treated by PCI therapy,while patients in the MT group were treated by MT therapy. The long-term effects and major adverse cardiac events were compared between the two groups. Results In MT group,1 patient died,the BMI compliance rate was 43. 75%（21/48）,the blood glucose compliance rate was 61. 54%（24/39）,the blood lipid compliance rate was 69. 05%（ 29/42 ）,and the blood pressure compliance rate was 88. 37%（ 38/43）;In PCI group,2 patients died,the BMI compliance rate was 45. 24%（19/42）,the blood glucose compliance rate was 67. 57%（25/37）,the blood lipid compliance rate was 75. 61%（31/41）,and the blood pressure compliance rate was 92. 31%（36/39）. There were no significant differences between the two groups（P all ﹥0. 05）. The major adverse cardiac events（MACE）rate was 22. 95%（14/61）in MT group,which was significantly lower than that of the PCI group（40. 98%,25/61）;While the incidence of stable angina（ SA）was 52. 46%（ 32/61 ）,which was significantly higher than that of the PCI group （34. 43%,21/61）,the differences were statistically significant（P all ﹤0. 05）. There were no significant differences in the TLR,MI,CD,UA or other events between the two groups（P all ﹥ 0. 05）. Conclusions For the clinical treatment of patients with CIL,if stenosis is not serious,PCI therapy is not necessary,blindly application may increase the risk of TLR,thus further increase the risk of MACE. The MT therapy can not only reduce the cost of treatment for patients to certain degree,but also has better prognosis and overall effect,so it is worthy of recommendation in clinics.