糖尿病患者急性心肌梗死后降糖治疗方案对心血管事件的影响

Effect of hypoglycemic therapy on cardiovascular events in diabetic patients after acute myocardial infarction

目的探讨在急性心肌梗死患者中采用不同方案治疗糖尿病的急性心肌梗死复发、充血性心力衰竭及死亡的综合风险。方法对2015年4月1日~2018年3月31日于上海中医药大学附属岳阳中西医结合医院住院的急性心肌梗死患者进行回顾性队列研究。在1432例急性心肌梗死患者中,无糖尿病患者1006例,无药物治疗糖尿病患者98例,口服降糖药治疗糖尿病患者241例,胰岛素治疗糖尿病患者87例。建立Cox比例风险模型,计算不同糖尿病治疗方案对于急性心梗患者预后的综合风险。结果糖尿病患者和无糖尿病患者的性别、高血压、心力衰竭和肾脏疾病比较,差异均有统计学意义(P<0.05)。经Cox回归调整年龄和相关因素,结果显示,与非糖尿病患者比较,无药物治疗患者(HR=1.37,95%CI:1.22~1.53)、口服降糖药治疗患者(HR=1.43,95%CI:1.31~1.56)和胰岛素治疗患者(HR=1.65,95%CI:1.48~1.84)结果存在的风险显著增加。结论胰岛素治疗的糖尿病患者的心血管事件发病率高于口服降糖药治疗的糖尿病患者和非糖尿病患者。

Objective To explore the comprehensive risk of acute myocardial infarction recurrence,congestive heart failure and death in patients with acute myocardial infarction using different options to treat diabetes.Methods A retrospective cohort study was conducted on patients with acute myocardial infarction who were hospitalized in Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine from April 1,2015 to March 31,2018.Among the 1432 with acute myocardial infarction,1006 patients were without diabetes,98 diabetic patients were without medication,241 diabetic patients were treated with oral hypoglycemic drugs,and 87 diabetic patients were treated with insulin.A Cox proportional hazard model was established to calculate the comprehensive risk of different diabetes treatment options for the prognosis of patients with acute myocardial infarction.Results The differences in gender,hypertension,heart failure,and kidney disease between diabetic and non-diabetic patients were statistically significant(P<0.05).After adjusting age and related factors by Cox regression,the results showed that compared with non-diabetic patients,there was a significant increase in risk among diabetic patients without medication(HR=1.37,95%CI:1.22-1.53),diabetic patients treated with oral hypoglycemic drugs(HR=1.43,95%CI:1.31-1.56)and insulin-treated patients(HR=1.65,95%CI:1.48-1.84).Conclusion The incidence of cardiovascular events in insulin-treated diabetic patients is higher than that in diabetic patients treated with oral hypoglycemic drugs and non-diabetic patients.