冠心病合并2型糖尿病患者血糖控制程度与支架内再狭窄的相关性研究

Correlation Between Blood Glucose Control and In-Stent Restenosis in Patients With Coronary Heart Disease Complicated With Type 2 Diabetes Mellitus

目的:探讨冠心病合并2型糖尿病患者血糖控制程度与支架内再狭窄的相关性。方法:选取2013-01至2016-12在我院行经皮冠状动脉介入治疗(PCI)后6~12个月复查冠状动脉造影的冠心病合并2型糖尿病患者544例,其中112例(20.6%)发生支架内再狭窄(再狭窄组),432例未发生狭窄(非再狭窄组)。再狭窄组患者根据糖化血红蛋白(Hb A_(1c))水平分为Hb A_1c<6.0%(n=40)、6.0%~7.0%(n=28)及>7.0%(n=44)三个亚组;根据Mehran分型,将支架内再狭窄分为:Ⅰ、Ⅱ、Ⅲ及Ⅳ型,分析Hb A_(1c)水平与支架内再狭窄发生情况以及再狭窄Mehran分型之间的关系。结果:再狭窄组中,Hb A_(1c)<6.0%、6.0%~7.0%及>7.0%的患者再狭窄比例分别为35.7%、25.0%和39.3%。Logistic多因素回归分析发现,与Hb A_(1c) 6.6%~7.0%患者相比,Hb A_(1c)<6.0%(RR=5.528,95%CI:3.819~8.159,P<0.001)和>7.0%(RR=3.692,95%CI:2.252~6.054,P<0.001)的患者发生支架内再狭窄的风险显著升高。Hb A_(lc)6.0%~7.0%的患者发生的再狭窄以MehranⅠ型为主;而Hb A_(1c)<6.0%和>7.0%患者以Ⅱ、Ⅲ、Ⅳ型再狭窄为主。结论:冠心病合并2型糖尿病患者Hb A_(lc)控制在6.0%~7.0%范围内的患者PCI后支架内再狭窄率最低,不同Hb A_(lc)控制水平的患者再狭窄类型不同。

Objectives：To investigate the correlation between blood glucose control level and in-stent restenosis in patients with coronary heart disease complicated with type 2 diabetes mellitus.Methods：A total of 544 patients with coronary heart disease complicated with type 2 diabetes mellitus,who were reexamined with coronary angiography within 6~12 months post percutaneous coronary intervention（PCI）in our hospital from January 2013 to December 2016,were enrolled in this study.Patients was divided into three groups according to the level of glycosylated hemoglobin（Hb A_（1c））：Hb A_（1c）6.0%,6.0%~7.0%and7.0%.The relationship between Hb A_（1c） level and in-stent restenosis and Mehran classification of in-stent restenosis was analyzed.Results：In-stent restenosis was detected in 112 patients（20.6%）.The ratio of in-stent restenosis was 35.7%,25%and39.3%in Hb A_（1c）6.0%,6.0%-7.0%and7.0%groups.Logistic multifactor regression analysis showed that the risk of instent restenosis in patients with Hb A_（1c）6.0%（RR=5.528,95%CI：3.819-8.159,P〈0.001）and Hb A_（1c）7.0%（RR=3.692,95%CI：2.252-6.054,P〈0.001）was significantly higher than in patients with Hb A_（1c） 6.6%-7.0%.In patients with Hb A_（1c） 6.0%-7.0%,the type of in-stent restenosis is mainly Mehran I,while in patients with Hb A_（1c）6.0%and Hb A_（1c）7.0%patients,the type of in-stent restenosis is mainly Mehran II,III and IV.Conclusions：The rate of in-stent restenosis was the lowest when Hb A_（1c） was controlled between 6.0%-7.0%in coronary heart disease patients complicated with type 2 diabetes after PCI,and the type of in-stent restenosis was different in patients with different levels of blood glucose control.