糖尿病对低密度脂蛋白胆固醇达标的冠心病患者支架内再狭窄的影响

Effects of diabetes mellitus on in-stent restenosis in coronary heart disease patients with LDL-C up to standard

目的:探讨糖尿病与低密度脂蛋白胆固醇(LDL-C)达标的冠状动脉粥样硬化性心脏病(冠心病)患者PCI术后支架内再狭窄的关系。方法:选取2012年6月至2018年12月确诊为冠心病且成功行PCI、术后1 a复查血管造影的患者368例,PCI术前查血清LDL-C均<1.8 mmol/L,其中合并糖尿病109例。以术后1 a内发生支架内再狭窄为终点事件,采用Logistic回归分析筛选再狭窄危险因素。结果:糖尿病组高血压患者比例,血清LDL-C、甘油三酯水平及支架内再狭窄发生率均高于非糖尿病组(P均<0.05)。Logistic回归分析结果显示,在调整了性别、高血压病史后,糖尿病、血清LDL-C和甘油三酯水平升高仍是LDL-C达标的冠心病患者PCI术后1 a内支架内再狭窄发生的危险因素,OR(95%CI)分别为2.752(1.644~4.609)、3.870(1.436~10.432)、3.028(1.928~4.754)。结论:糖尿病为冠心病患者PCI术后支架内再狭窄的主要危险因素,糖尿病合并冠心病患者PCI术后应加强降脂治疗。

Aim:To explore the effects of diabetes mellitus on in-stent restenosis(ISR)after percutaneous coronary intervention(PCI)of coronary artery disease(CAD)patients with standard level of low-density lipoprotein(LDL-C).Methods:The data of 368 CAD patients receiving PCI from June 2012 to December 2018 were collected,the serum LDL-C levels before PCI were all less than 1.8 mmol/L,and 109 out of them were complicated with diabetes mellitus.Angiography was reexamined to evaluate ISR 1 year after PCI.Logistic regression analysis was used to screen the influencing factor of ISR.Results:The proportion of hypertension,the serum levels of LDL-C and triglyceride,and the incidence of ISR of diabetic group were higher than those of the non-diabetic group(P<0.05).The results of Logistic regression analysis showed that diabetes mellitus,high levels of LDL-C and triglyceride were still the risk factors of ISR after adjusting the influence of gender and hypertension,and OR(95%CI)was 2.752(1.644-4.609),3.870(1.436-10.432),3.028(1.928-4.754),respectively.Conclusion:Diabetes mellitus is a main risk factor of ISR after PCI of CAD patients.The patients with diabetes mellitus and CAD should further strengthen the treatment of lipid-lowering after PCI.