伴2型糖尿病的急性心肌梗死经皮冠脉介入治疗术中无复流的因素分析及建议探讨

Analysis of factors of no-reflow during PCI for acute myocardial infarction with type 2 diabetes mellitus and discussion of suggestions

目的:探讨伴2型糖尿病(T2MD)的急性心肌梗死(AMI)患者经皮冠脉介入治疗(PCI)术中无复流的因素,并提出建议。方法:对沧州市中心医院2017-01-2019-06期间收治的352例伴T2MD的AMI患者的临床资料展开回顾性分析,均实施PCI手术,统计术中无复流发生率,分析其影响因素。结果:所选受试者中共有51例患者PCI术中无复流,无复流发生率为14.49%;发生者中T2MD病程>10年、降糖治疗不依从、胰岛素抵抗指数(IRI)>2.5、Killip分级3/4级、冠脉近端栓塞、肌钙蛋白T(cTnT)峰值>2.0 nmol/L占比均高于未发生者(P<0.05),经Logistic回归分析可知上述自变量均为伴T2MD的AMI患者PCI术中无复流的独立危险因素(OR=6.482、6.567、5.789、5.948、6.141、5.463,均P<0.05)。结论:伴T2MD的AMI患者PCI术中无复流的风险高,其中T2MD病程>10年、降糖治疗不依从等均是其独立危险因素,需予以针对性防控。

Objective:To explore the factors of no reflow during percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI)with type 2 diabetes mellitus(T2 MD),and to make recommendations.Method:The clinical data of 352 AMI patients with T2 MD admitted to Cangzhou Central Hospital from January 2017 to June 2019 were analyzed retrospectively.All patients underwent PCI.The incidence of no-reflow during operation was counted and the influencing factors were analyzed.Result:There were 51 patients who had no reflux during PCI,and the incidence of no reflux was 14.49%.Among the patients with T2 MD,the proportion of duration>10 years,non-compliance with hypoglycemic therapy,insulin resistance index>2.5,Killip grade 3/4,proximal coronary embolism,troponin T(cTnT)peak>2.0 nmol/L were higher than those without T2 MD(P<0.05).Logistic regression analysis showed that the above independent variables were independent risk factors for no-reflow in AMI patients with T2 MD during PCI(OR=6.482,6.567,5.789,5.948,6.141,5.463,all P<0.05).Conclusion:There is a high risk of no-reflow in AMI patients with T2 MD during PCI.The duration of T2 MD>10 years,non-compliance with hypoglycemic therapy and so on are independent risk factors,which need to be prevented and controlled.