糖化血红蛋白对糖尿病伴冠心病患者PCI后主要心血管不良事件的影响

Influence of glycosylated hemoglobin on major adverse cardiovascular events in patients with diabetes mellitus complicated coronary heart disease after PCI

目的:研究糖化血红蛋白(HbA1c)对糖尿病伴冠心病患者经皮冠状动脉介入治疗术(PCI)后主要心血管不良事件(MACE)的影响。方法:选择本院收治的100例PCI术后糖尿病伴冠心病患者,根据HbA1c水平分为HbA1c<6.5%组(48例),HbA1c≥6.5%(52例)。比较两组患者PCI术前C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、血沉(ESR)以及白细胞介素6(IL-6)水平,同时观察两组患者在PCI术后6个月以及24个月时MACE发生率。结果:与HbA1c<6.5%组比较,HbA1c≥6.5%组术前血清CRP[(18.5±6.2)mg/L比(25.8±4.2)mg/L]和TNF-α[(32.4±12.3)ng/L比(48.3±11.8)ng/L]水平明显升高(P均<0.01);术后6个月,HbA1c≥6.5%组心梗发生率明显高于HbA1c<6.5%组(9.62%比0,P=0.028);术后24个月,与HbA1c<6.5%组比较,HbA1c≥6.5%组心梗(2.08%比15.38%)和病变血管再狭窄(12.50%比32.69%)发生率明显升高(P均<0.05)。结论:糖尿病伴冠心病患者经皮冠状动脉介入治疗术后糖化血红蛋白水平低的预后较好。

Objective： To study influence of glycosylated hemoglobin Alc （HbA1c） on major adverse cardiovascular events （MACE） in patients with diabetes mellitus （DM） complicated coronary heart disease （CHD） after percutaneous coronary intervention （PCI）. Methods： A total of 100 DM ＋ CHD patients after PCI were selected from our hospital. According to HbA1c level, they were divided into HhA1c〈6.5% group （n = 48） and HbA1c≥6.5% group （n = 52）. Levels of C reactive protein （CRP）, tumor necrosis factor α （TNF-α）, erythrocyte sedimentation rate （ESR） and interleukin （IL） - 6 before PCI, incidence rate of MACE on six and 24 months after PCI were compared between two groups. Results： Compared with HbA1c（6.5% group before PCI, there were significant rise in serum levels of CRP [（18.5±6.2） mg/Lvs. （25.8±4.2） mg/L] andTNF-α [（32.4±12.3） ng/Lvs. （48.3±11.8） ng/ L] in HbA1c≥6.5% group, P〈0.01 both. On six months after PCI, incidence rate of myocardial infarction in HbA1c≥6. 5% group was significantly higher than that of HbA1c〈6.5% group （9.62% vs. 0, P = 0. 028）; 24 months after PCI, compared with HbA1c（6.5% group, there were significant rise in incidence rates of myocardial infarction （2.08% vs. 15.38%） and diseased vessel restenosis （12.50% vs. 32.69%） in HbA1c≥6.5% group （P （0.05 all）. Conclusion： In DM ＋ CHD patients after PCI, those with lower HbA1c level possess better prognosis.