冠心病伴2型糖尿病患者PCI治疗后他汀类药物服用时程与其不良事件的相关分析

The relationship between duration of statins therapy post PCI and adverse events in coronary heart disease patients combined with type 2 diabetes

目的探讨他汀类药物是否坚持服用与冠心病伴糖尿病患者经皮冠状动脉介入治疗术(PCI)治疗远期预后的关系。方法回顾性分析2009年5月至2010年5月330例经PCI治疗的冠心病伴糖尿病患者的临床资料,按照是否坚持服用他汀类药物分成服用他汀组和停用他汀组。收集两组患者的相关指标,进行为期3年的随访。比较两组患者他汀类药物服用时程、停药原因、主要不良心脑血管事件(MACCE)及因血糖异常入院等情况的发生率。结果 3年随访期间,234例(70.91%)患者坚持服用他汀类药物(服用他汀组),96例(29.09%)患者停用了他汀类药物(停用他汀组),停药原因包括出现皮疹3例(3.12%),ALT升高3倍以上3例(3.12%),消化道不适1例(1.04%)以及无明确原因自行停药89例(92.71%)。停用他汀组再发心绞痛(23.96%vs 10.68%,P<0.01)、再次PCI(25.00%vs 7.69%,P<0.01)及MACCE(34.38%vs 26.92%,P<0.05)发生率显著高于坚持服用组患者。所有患者均未出现因血糖异常而入院的情况。结论冠心病伴2型糖尿病经PCI治疗的患者应坚持服用他汀类药物,本研究中,他汀类药物未增加血糖异常入院风险。

Objective To explore the relationship between the patients＇ compliance of statins therapy post percutaneous coronary intervention（ PCI） and long-term prognosis in coronary heart disease（ CHD） patients combined with type 2 diabetes. Methods The clinical data of 330 CHD patients combined with type 2 diabetes underwent PCI were retrospectively analyzed,and the patients were divided into persisting group and outage group according to whether or not persisting medication. The followed up period was three years to compare related indexes including the duration of statins use,the cause of withdrawing statins,the major adverse cardiovascular and cerebrovascular events（ MACCE） and admission because of abnormal glucose. Results Out of 330 cases,234（ 70. 91%） persisted taking statins（ persisting group）,96（ 29. 09%） withdrew statins（ outage group） during the 3-year follow-up. The reasons giving up statins use included arising skin rash in 3cases（ 3. 12%）,alanine aminotransferase（ ALT） increased for more than 3 times in 3cases（ 3. 12%）,digestive discomfort in 1case（ 1. 04%） and drug withdrawal by oneself because of unknown causes in 89 cases（ 92. 71%）. Compared with persisting group,the incidences of recurrent angina pectoris（ 23. 96% vs 10. 68%,P〈0. 01）,PCI again（ 25. 00% vs 7. 69%,P〈0.01） and MACCE（ 34. 38% vs 26. 92%,P〈0. 05） increased significantly in outage group. No patients were admitted in hospital because of abnormal glucose. Conclusion All CHD patients combined with type 2 diabetes underwent PCI should insist in statins medication. In present study,statins therapy does not increase readmission risk because of abnormal blood glucose.