糖化血红蛋白水平对2型糖尿病伴急性心肌梗死患者经皮冠状动脉介入术预后及支架内再狭窄程度的影响

Effects of glycosylated hemoglobin level on the prognosis of patients with type 2 diabetes mellitus with acute myocardial infarction after percutaneous coronary intervention and the degree of stent restenosis

目的探讨糖化血红蛋白(HbA1c)水平对2型糖尿病伴急性心肌梗死患者经皮冠状动脉介入术预后及支架内再狭窄程度的影响。方法选择2015年3月至2018年3月于驻马店市中心医院行冠状动脉介入术治疗的2型糖尿病合并急性心肌梗死患者162例为研究对象。根据术后6个月HbA1c水平分为A组(HbA1c≤5.6%)(n=38)、B组(5.6%<HbA1c<6.5%)(n=71)和C组(n=53)(HbA1c≥6.5%)。比较术后6个月3组患者空腹血糖、血脂水平、肾小球滤过率、心血管不良事件发生率及支架内再狭窄发生率。结果术后6个月,3组患者总胆固醇、三酰甘油、低密度脂蛋白、高密度脂蛋白水平及肾小球滤过率两两比较差异无统计学意义(P>0.05);3组患者空腹血糖水平两两比较差异均有统计学意义(P<0.05)。术后6个月,A组、B组、C组患者心血管不良事件发生率分别为23.7%(9/38)、5.6%(4/71)、26.4%(14/53),支架内再狭窄发生率分别为34.1%(13/38)、11.3%(8/71)、28.3%(15/53);A组和C组患者心血管不良事件发生率和支架内再狭窄发生率显著高于B组(χ^2=6.062、10.560、8.381、5.832,P<0.05),A组与C组患者心血管不良事件发生率和支架内再狭窄发生率比较差异无统计学意义(χ^2=0.091、0.362,P>0.05)。结论5.6%<HbA1c<6.5%时2型糖尿病伴急性心肌梗死患者经皮冠状动脉介入术后的预后效果显著优于HbA1c≤5.6%及HbA1c≥6.5%,且术后6个月支架再狭窄率低,狭窄程度轻。

Objective To investigate the effect of glycosylated hemoglobin(HbA1c)on the prognosis of percutaneous coronary intervention and stent restenosis in patients with type 2 diabetes mellitus with acute myocardial infarction.Methods A total of 162 patients with type 2 diabetes complicated with acute myocardial infarction who underwent coronary intervention in the Central Hospital of Zhumadian City from March 2015 to March 2018 were selected as subjects.The patients were divided into group A(HbA1c≤5.6%)(n=38),group B(5.6%<HbA1c<6.5%)(n=71)and group C(HbA1c≥6.5%)(n=53)according to the level of HbA1c at six months after surgery.The fasting blood glucose,lipid level,glomerular filtration rate,incidence of adverse cardiovascular events and incidence of stent restenosis in the three groups were compared at six months after surgery.Results At six months after the operation,there was no significant difference in total cholesterol,triglyceride,low density lipoprotein,high density lipoprotein and glomerular filtration rate among the three groups(P>0.05).There was statistic different in the fasting glucose level of patients among the three groups(P<0.05).At six months after the operation,the incidence of adverse cardiovascular events in the group A,group B and group C was 23.7%(9/38),5.6%(4/71)and 26.4%(14/53),respectively,and the incidence of stent restenosis was 34.1%(13/38),11.3%(8/71)and 28.3%(15/53),respectively.The incidence of cardiovascular adverse events and the incidence of stent restenosis in the group A and group C was significantly higher than that in the group B(χ^2=6.062,10.560,8.381,5.832;P<0.05),while there was no significant difference in the incidence of cardiovascular adverse events and the incidence of stent restenosis between the group A and group C(χ^2=0.091,0.362;P>0.05).Conclusion When 5.6%<HbA1c<6.5%,the prognosis of patients with type 2 diabetes with acute myocardial infarction after percutaneous coronary intervention is significantly better than that of the patients with HbA1c≤5.6%and HbA1c≥6.5%,and the stent restenosis rate is lower and the stenosis degree is milder at six months after surgery.