急性ST段抬高型心肌梗死合并糖尿病患者的临床特征及预后分析

Clinical features and prognosis of patients with acute ST-segment elevation myocardial infarction comorbid with diabetes mellitus

目的探讨合并糖尿病的急性ST段抬高型心肌梗死(ST-segment elevation myocardial inf arction,STEMI)患者的临床特征,分析行直接经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后12个月内的预后情况。方法按标准入选的375例STEMI患者分为两组,合并糖尿病的STEMI患者140例作为糖尿病组,血糖正常的STEMI患者235例作为血糖正常组。分别对两组患者的临床资料、冠状动脉病变特征、置入支架类型、术后慢血流/无复流发生率、住院期间死亡率、术后12个月内的预后情况进行比较。结果糖尿病组患者年龄[(63.0±12.5)岁比(58.1±13.6)岁,P=0.001]、高血压病(59.3%比37.9%,P<0.001)、高脂血症(53.6%比37.4%,P=0.002)、入院时Killip心功能分级≥Ⅲ级(9.3%比3.8%,P=0.030)比例均高于血糖正常组,差异均有统计学意义;糖尿病组患者吸烟率(55.0%比72.8%,P<0.001)低于血糖正常组,差异有统计学意义;糖尿病组患者三支血管病变(40.7%比28.9%,P=0.019)、合并左主干病变(13.6%比7.2%,P=0.044)比例及术后慢血流/无复流(12.9%比5.5%,P=0.013)发生率高于血糖正常组,差异均有统计学意义;单支血管病变(27.9%比44.7%,P=0.001)比率低于血糖正常组,差异有统计学意义。糖尿病组患者住院期间的死亡率(6.4%比1.7%,P=0.020)、术后12个月内再次血运重建(7.9%比0.9%,P=0.001)及心力衰竭(7.9%比2.6%,P=0.017)发生率均高于血糖正常组,差异均有统计学意义。结论合并糖尿病的STEMI患者平均年龄较大,入院时Killip心功能分级≥Ⅲ级的比率较高,高血压病、高脂血症、三支血管病变、左主干病变发生率较高,住院期间死亡率较高,术后随访期内心源性死亡率及再发心肌梗死发生率未见明显升高,此类患者可能从早期介入治疗中获益更大。

Objective To investigate the clinical f eatures of patients with acute ST-segment elevation myocardial infarction（STEMI） comorbid with diabetes mellitus（DM） and to analyze the prognosis within 12 months af ter primary percutaneous coronary intervention（pre-PCI）.Methods A total of 375 STEMI patients were divided into the diabetes group（n =140） and the normal blood glucose group（n=235） according to whether they met the diagnostic criteria of DH. The clinical data,characteristics of coronary artery lesions,type of stent implant,rate of coronary slow flow or no-reflow af ter pre-PCI, and the prognosis within 12 months af ter PCI of the two groups were investigated.Results Patient in t he dia betes grou p presented wit h higher mea n age, higher comorbid rates of hypertension, hyperlipidemia and heart function of Killip class Ш and above than patients in the normal blood glucose group（all P〈0.05）. patients in the diabetes group had higher rates of slow ref low/no-ref low af ter PCI（12.9% vs.5.5%,P =0.013）,higher percentages of 3-ressel disease（40.7% vs. 28.9%,P =0.019）and lef t main lesions（13.6% vs. 7.2%,P =0.044）.The in-hospital mortality rates（6.4% vs. 1.7%, P=0.020）,revascularization rates within 12 months（7.9% vs.0.9%,P =0.001）and incidence of heart f ailure（7.9% vs. 2.6%,P =0.017）were all higher in the diabetes group. Conclusions STEMI patients comor bid with DM were relatively older, had higher comorbidities of hypertension,hyperlipidemia, three-vessel disease, lef t main coronary lesions and higher mortality during hospitalization. No signif icant increase in cardiac death and recurrent myocardial inf arction were deserved during the f ollow-up period. These patients may benef it more f rom early intervention.