2型糖尿病的治疗策略与药物支架内再狭窄及远期预后的相关性研究

Study on correlation between the treatment strategies of type 2 diabetes mellitus and instent restenosis as well as long-term prognosis of PCI

目的研究2型糖尿病(T_2DM)的不同治疗策略与支架内再狭窄(Instent restenosis,ISR)及远期预后的相关性。方法回顾性分析2012-2015年870例复查冠脉造影的经皮冠状动脉成形术后(Percutaneous coronary intervention,PCI)患者的临床资料,其中T_2DM患者389例,根据不同的治疗策略分为3组(单纯饮食控制组、口服药物组和胰岛素组),统计各组的ISR率及全因死亡、心肌梗死(MI)、靶血管血运重建(TVR)等主要不良心血管事件(Major adverse cardiac events,MACE)发生情况。探讨T_2DM的不同治疗策略是否会影响支架内ISR的发生及远期预后。同时将所有患者分为ISR组和无ISR组,分析冠心病相关危险因素与支架内ISR的关系。结果所有ISR患者中,T_2DM患者较非糖尿病(NT_2DM)患者ISR率明显升高(55.6%vs.42.6%,P=0.006),其中胰岛素组ISR率明显升高(P=0.047),而饮食控制组与口服药物组ISR率比较差异无统计学意义。糖化血红蛋白水平与ISR率呈正相关(回归系数为0.658,P=0.008);T_2DM患者再发MI、全因死亡、TVR及总MACE比例均高于NT_2DM患者,差异有统计学意义(P<0.01),其中胰岛素组再发MI及全因死亡比例高于另外两组(P<0.05)。结论合并2型糖尿病(尤其是需要使用胰岛素的患者)更易于发生ISR,且PCI术后MACE发生比例较高。

Objective To study the relationship between the treatment strategies of type 2 diabetes mellitus（T2DM） and instent restenosis（ISR） as well as long-term prognosis of percutaneous coronary intervention（PCI）.Methods Totally 870 patients with PCI who had undergone coronary angiography from 2012 to 2015 were analyzed retrospectively,in which 389 patients with T2DM were divided into 3 groups according to different treatment strategies of T2DM（including diet control group,oral drug group and insulin group）.The ISR rate,all-eause mortality and the major adverse cardiac events（MACE） of MI and TVR were analyzed.Whether the different treatment strategies of type 2 diabetes can affect the incidence of ISR and long-term prognosis was explored.All the patients were divided into ISR group and non-ISR group,and the relationship between the related risk factors of coronary heart disease and ISR was analyzed.Results The ISR rate of T2DM group was higher than that of NT2DM group（55.6%vs.42.6%,P =0.006）,and the ISR rate in insulin group increased significantly（P = 0.047）,while no significant difference was found between diet control group and oral drug group（P〉 0.05）.The glycated hemoglobin level was positively correlated with ISR rate（regression coefficient was 0.658,P=0.008）.The proportion of MI,all-eause mortality,TVR and MACE in T2DM group was higher than that of NT2DM group（P〈 0.01）,and the proportion of MI and all-cause mortality in insulin group were higher than those of the other two groups.Conclusion Patients with PCI combined with T2DM are more prone to ISR with higher incidence of MACE /especially the patients who use insulin.