糖尿病患者冠状动脉旁路移植术后胸痛复发特征的分析

Characteristic analysis of chest pain recurrence in patients with diabetes mellitus after coronary artery bypass grafting

目的:分析糖尿病患者行冠状动脉旁路移植术(CABG)后胸痛复发的临床特征和桥血管病变特点。方法:连续入选2002年11月至2016年12月,北京安贞医院心内科,以CABG术后再发胸痛为主要原因首次住院并完成冠状动脉造影的患者797例,其中男性627例,女性170例。按照患者有无糖尿病分为糖尿病组(301例)和非糖尿病组(496例)。记录入选病例的基本临床信息和实验室检查指标。根据冠状动脉造影结果记录血管病变程度及病变部位。分析两组既往病史、造影距离CABG时间、桥血管的病变程度和病变部位的差异。结果:糖尿病组男性比例低于非糖尿病组(P=0.005),高血压比例高于非糖尿病组(P=0.004)。比较两组冠状动脉造影距离CABG的时间,糖尿病组<6个月(P=0.003)及6个月~1年(P=0.029)的比例均低于非糖尿病组,1~5年的比例高于非糖尿病组(P=0.018)。糖尿病组红细胞计数(P=0.027)、血肌酐(P=0.006)、尿酸(P=0.004)以及CDL-C(P=0.009)均低于非糖尿病组,空腹血糖高于非糖尿病组(P<0.001)。两组乳内动脉桥、静脉桥的病变程度和病变部位未见显著差异。结论:有无糖尿病在乳内动脉桥和静脉桥病变程度和部位方面无明显差异。糖尿病患者CABG后复发胸痛多出现在术后1~5年,糖尿病规范治疗对于改善CABG的预后具有重要意义。

Objective： To analyze the clinical features of diabetic patients with chest pain recurrence after coronary artery bypass grafting（ CABG） and the characteristics of the graft lesion. Methods： 797 patients（ 627 males and 170 females） with chest pain recurrence after CABG were chosen from Beijing Anzhen Hospital from Nov. 2002 to Dec. 2016 and all patients were divided into diabetic group（ 301 cases） and non-diabetic group（ 496 cases）. Clinical data and laboratory indexes were recorded. The lesion and its distribution were also recorded according to the result of coronary angiography. Independent samples t test and Mann-Whitney U test were used to compare the difference of laboratory indexes between the two groups. Chi square test was used to compare the two groups in terms of the past history,the interval from CABG to angiography,the severity and distribution of lesions. Results： The proportion of men in the diabetes group was lower than that in the non-diabetes group（ P = 0. 005） while hypertension was more common in diabetics group（ P = 0. 004）. There are lower erythrocyte count（ P = 0. 027）,serum creatinine（ P = 0. 006）,uric acid（ P = 0. 004）,low-density lipoprotein cholesterol（ P = 0. 009） and higher fast blood sugar（ P〈0. 001） seen in the diabetes group. Receiving coronary angiography less than 6 months（ P = 0. 003） and 6 months to 1 year after CABG are more common in non-diabetic group（ P = 0. 029） while 1-5 years are more common in diabetic group（ P = 0. 018）. There was nosignificant difference between the two groups in the severity and distribution of lesions in terms of internal mammary artery and vein graft.（ P〈0. 05）. Conclusion： There was no significant difference in the severity and distribution of the lesion in terms of the internal mammary artery graft and the vein graft. The impact of diabetes on patients with chest pain recurrence mainly occurs in 1-5 years after CABG and the standard treatment of diabetes has a positive effect in the prognosis of CABG.