糖尿病合并冠状动脉分叉病变PCI围术期阿托伐他汀强化治疗患者血浆BNP和hs-CRP水平与其远期预后的关系分析

Analysis on the correlation between plasma BNP and hs-CRP levels and its long-term prognosis in patients with diabetes mellitus complicated with coronary bifurcation lesions undergoing intensive atorvastatin treatment during PCI perioperative period

目的探讨治疗糖尿病合并冠脉分叉病变经皮冠脉介入治疗术(PCI)围术期阿托伐他汀强化治疗患者血浆脑钠肽(BNP)和高敏C反应蛋白(hs-CRP)水平与其远期预后的关系。方法前瞻性选取我院2017年9月至2019年2月糖尿病合并冠脉分叉病变患者60例,依据数字随机法分为联合组和对照组,每组各30例。对照组给予PCI治疗,联合组在PCI治疗基础上联合阿托伐他汀治疗。比较两组手术时间、术后住院时间、最终球囊对吻扩张成功率、住院费用、不良反应发生率、治疗前后的血浆BNP、hs-CRP水平、随访1年再狭窄率和死亡率等,并分析患者血浆BNP和hs-CRP水平对其再狭窄发生情况和1年生存情况的影响。结果两组手术时间、住院时间、最终球囊对吻扩张成功率、住院费用、不良反应发生率比较差异无统计学意义(P>0.05);联合组术后1 d、3 d和7 d的血浆BNP、hs-CRP明显低于对照组(P<0.05);随访一年后,联合组的再狭窄率明显低于对照组(P<0.05);两组患者1年死亡率差异比较无统计学意义(P>0.05)。再狭窄患者的血浆BNP、hs-CRP明显高于无再狭窄患者,死亡患者的血浆BNP、hs-CRP明显高于生存患者(P<0.05);Logistic分析结果显示,血浆BNP和hs-CRP水平均可影响其再狭窄发生情况和1年生存情况(P<0.05)。结论阿托伐他汀联合PCI能够改善糖尿病合并冠脉分叉病变患者的血浆BNP和hs-CRP,且血浆BNP和hs-CRP与糖尿病合并冠脉分叉病变患者的发生发展有关,提示监测其水平可评估患者的远期预后。

Objective To research the correlation between plasma brain natriuretic peptide(BNP)and high sensitivity C-reactive protein(hs-CRP)levels and its long-term prognosis in patients with diabetes mellitus complicated with coronary bifurcation lesions undergoing intensive atorvastatin treatment during percutaneous coronary intervention(PCI)perioperative period.Methods A total of 60 patients with diabetes mellitus complicated with coronary bifurcation lesions admitted to our hospital form September 2017 to February 2019 were prospectively selected and divided into the combined group(n=30)and the control group(n=30)according to the random number table method.Patients in the control group were treated with PCI,while those in the combined group were treated with atorvastatin on the basis of PCI.The operation time,postoperative hospitalization time,final kissing balloon inflation success rate,hospitalization expenses,incidence of adverse reactions(ADRs),plasma BNP and hs-CRP levels before and after treatment,restenosis rate and mortality after 1 year of follow-up were compared between the two groups.Meanwhile,the impacts of plasma BNP and hs-CRP levels of patients on occurrence of restenosis and 1-year survival were analyzed.Results There were no statistically significant differences in operation time,hospitalization time,final kissing balloon inflation success rate,hospitalization expenses and incidence of ADRs between the two groups(P>0.05).The levels of plasma BNP and hsCRP in the combined group were significantly lower than those in the control group on the first,third and seventh day after operation(P<0.05).After one year of follow-up,the incidence of restenosis in the combined group was significantly lower than that in the control group(P<0.05).There was no statistically significant difference in 1-year mortality between the two groups of patients(P>0.05).The levels of plasma BNP and hsCRP in patients with restenosis were significantly higher than those in patients without restenosis.And the plasma levels of BNP and hsCRP in dead patients were significantly higher than those in survival patients(P<0.05).The results of logistic analysis proved that plasma BNP and hsCRP levels could impact the occurrence of restenosis and 1-year survival(P<0.05).Conclusion Atorvastatin combined with PCI can improve plasma BNP and hsCRP in patients with diabetes mellitus complicated with coronary bifurcation lesions.And plasma BNP and hsCRP are related to the occurrence and development of patients with diabetes mellitus complicated with coronary bifurcation lesions.It is suggested that the long-term prognosis of patients be evaluated by monitoring its levels.