合并糖耐量减低的冠心病支架植入术后患者的长期临床转归

Long-term clinical outcome of post-coronary artery stent implantation patients with impaired glucose tolerance

目的评估糖耐量减低对冠心病支架植入术后患者长期临床转归的影响。方法搜集我院2001—2014年资料完整、完全再血管化并且随访期糖代谢类型维持稳定的冠心病患者714例,根据初次空腹、餐后血糖或糖尿病史分为糖代谢正常组(NGT)260例、糖耐量减低组(IGT)229例及2型糖尿病组(DM)225例,平均随访(43.42±33.82)月,比较其血脂、血糖、颈动脉内膜中层厚度(IMT)、主要心血管事件(心血管死亡、非致死性心梗、心绞痛、心衰)、新发严重狭窄病变(≥75%参考血管)和支架内再狭窄发生率等。结果随访结束时,在血脂、吸烟量、血压控制相当的情况下,IGT组主要心血管事件、新发严重狭窄和支架内再狭窄发生率明显高于NGT组(分别为18.78%比9.62%,57.83%比38.82%,P<0.05);而与DM组(分别23.11%,63.75%)差别不明显。多因素回归分析显示,糖化血红蛋白增高是IGT组不良预后的主要影响因子(OR2.146,95%CI 1.558-2.956)。结论 IGT血糖异常可能是冠心病支架植入术后患者预后不良的重要影响因子。

Objective To evaluate the effect of impaired glucose tolerance on the long-term clinical outcome of patients with coronary heart disease（ CHD） after stent implantation. Methods 714 patients with CHD were collected in our hospital from 2001 to 2014,with integrity of information,complete revascularization and stability of the follow-up sugar metabolic type. According to the first fasting,postprandial 2 hours blood glucose or diabetes history,all patients were divided into three group, including normal glucose tolerance（ NGT） group with 260 patients,impaired glucose tolerance（ IGT） group with 229 patients and type 2 diabetes mellitus（ DM） group with225 patients. The mean follow-up time was 43.42± 33.82 months. The blood lipids,blood sugar,carotid intimamedia thickness（ IMT）,major cardiovascular events（ cardiovascular death,nonfatal MI,angina,heart failure）,the incidence of new severe stenosis（ ≥75% reference vessel） and in-stent restenosis were measured. Results In the case of blood lipids,smoking and blood pressure control,the incidence of major cardiovascular events,new severe stenosis and in-stent restenosis were significantly higher in IGT group than those in NGT group（ 18.78% vs 9.62,57.83% vs 38.82%, respectively, P〈0. 05）. But it was not significantly different from DM group（ 23. 11%,63.75%,respectively） with higher blood sugar. Multivariate regression analysis showed that increased glycosylated hemoglobin was the main prognostic factor of IGT group（ OR2.146,95%CI 1.558-2.956）. Conclusion IGT with high glycemia may be an important poor prognosis factor for post-coronary artery stent implantation patients with CHD.