冠心病合并糖尿病患者血浆6-酮前列腺素F1α水平及随访研究

Plasma 6-Ketoprostaglandin F1αLevel of Patients with Coronary Heart Disease Combined with Diabetes and Follow-up Studies

目的检测冠心病(CHD)合并糖尿病患者血浆6-酮前列腺素F1α(6-K-PGF_(1α))水平,随访其主要不良心血管事件(MACE)和再住院发生情况。方法选取2013年7月—2014年6月在华北理工大学附属医院住院的CHD患者270例,根据是否合并糖尿病分为合并糖尿病组(n=134)和不合并糖尿病组(n=136)。记录患者临床情况,测量身高、体质量、血压、心率等,完善心电图、超声心动图、冠状动脉造影等检查。检查血常规、凝血功能及生化指标。测定两组患者6-K-PGF_(1α)水平。随访1年,记录两组患者MACE发生及再住院情况。结果两组性别、有无介入治疗、年龄、BMI、收缩压、舒张压、心率、冠状动脉病变数、冠状动脉严重病变数及超敏C反应蛋白(hs-CRP)、血肌酐(SCr)、血尿酸(UA)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平间差异均无统计学意义(P>0.05)。合并糖尿病组6-K-PGF_(1α)水平低于不合并糖尿病组,差异有统计学意义(P<0.05)。冠状动脉病变数、冠状动脉严重病变数、hs-CRP水平、收缩压与6-K-PGF_(1α)水平均呈直线负相关(r值分别为-0.218、-0.155、-0.139、-0.120,P<0.05)。其中对于合并糖尿病组,冠状动脉病变数、BMI、hs-CRP水平、TC水平与6-K-PGF_(1α)水平呈直线负相关(r值分别为-0.194、-0.179、-0.146、-0.126,P<0.05);对于不合并糖尿病组,冠状动脉病变数、收缩压、hs-CRP水平、冠状动脉严重病变数与6-K-PGF_(1α)水平呈直线负相关(r值分别为-0.241、-0.193、-0.176、-0.175,P<0.05)。两组MACE发生率间差异无统计学意义(P>0.05);而合并糖尿病组再住院率高于不合并糖尿病组,差异有统计学意义(P<0.05)。结论 CHD合并糖尿病患者6-K-PGF_(1α)水平较低,再住院风险增加。因此,对于CHD合并糖尿病患者应该进一步强化抗血小板治疗、保护血管内皮功能。

Objective To detect the level of plasma 6- Ketoprostaglandin F1α（ 6- K- PGF_（1α）） of patients with coronary heart disease（ CHD） combined with diabetes, and to investigate patients＇ major adverse cardiovascular events（ MACE） and occurrence of rehospitalization. Methods 270 CHD patients,who were in North China University of Science and Technology Affiliated Hospital from July 2013 to June 2014, were selected. According to whether combined with diabetes,patients were divided into group combined with diabetes（ n = 134） and group without diabetes（ n = 136）. The clinical condition of the patients was recorded, height, weight, blood pressure, heart rate were measured, and examinations of electrocardiogram, echocardiography, and coronary angiography were carried out. Blood routine, blood clotting function,biochemical indicators were examined. 6- K- PGF_（1α）level of patients in two groups was detected. Follow- up lasted for one year,MACE events and rehospitalization situation of patients in two groups were recorded. Results The comparison of gender,interventional treatment,age,BMI,systolic blood pressure,diastolic blood pressure,heart rate,number of coronary artery lesions,number of severe coronary lesions and levels of sensitivity C- reactive protein（ hs- CRP）,serum creatinine（ SCr）,uric acid（ UA）, total cholesterol（ TC）, triglyceride（ TG）, low density lipoprotein cholesterol（ LDL-C）, high density lipoprotein cholesterol（ HDL-C） between two groups were not significantly different（ P〉0. 05）. The 6- K- PGF_（1α）level of patients in group combined with diabetes were significantly lower than that in group without diabetes（ P〈0. 05）. The number of coronary artery lesions,number of severe coronary lesions,hs- CRP level,systolic blood pressure presented a negative linear correlation with 6- K- PGF_（1α）level（ r value was- 0. 218,- 0. 155,- 0. 139,- 0. 120 respectively; P〈0. 05）. For group combined with diabetes, the number of coronary artery lesions, BMI, hs- CRP level, TC level showed a negative linear correlation with 6- K- PGF_（1α）level（ r value was- 0. 194,- 0. 179,- 0. 146,- 0. 126 respectively; P〈0. 05）; for group combined without diabetes,the number of coronary artery lesions,systolic pressure,hs- CRP level,number of severe coronary lesions manifested a negative linear correlation with 6- K- PGF_（1α）level（ r value was- 0. 241,- 0. 193,- 0. 176,- 0. 175respectively; P〈0. 05）. The occurrence rates of MACE in two groups were not significantly different（ P〉0. 05）; the rehospitalization rate of group combined with diabetes was significantly higher than that of group combined without diabetes（ P〈0. 05）. Conclusion The 6- K- PGF_（1α）level of CHD patients with diabetes is lower,while the risk of hospitalization again is increased. Therefore,CHD patients combined with diabetes should further strengthen anti- platelet therapy and protect vascular endothelial function.