2型糖尿病对女性冠心病多支血管病变患者不完全血运重建后预后的影响研究

Impact of Type 2 Diabetes Mellitus on Prognosis after Incomplete Revascularization in Female Coronary Heart Disease Patients with Multivessel Disease

背景2型糖尿病(T2DM)是冠心病的等危症,约80%的T2DM患者死于心血管疾病。目前有关T2DM对女性冠心病多支血管病变(MVD)患者预后影响的研究报道较少。目的探讨T2DM对女性冠心病MVD患者不完全血运重建(IR)后预后的影响。方法选取2010—2017年在南方医科大学第二临床学院附属郑州人民医院行IR的女性冠心病MVD患者638例,根据有无T2DM分为T2DM组(n=122)和无T2DM组(n=516)。比较两组患者临床资料、冠状动脉病变特征、住院期间及IR后36个月内心血管事件发生率。结果T2DM组患者MVD类型为三支病变者占比、病变部位为左主干者占比、合并慢性完全闭塞病变(CTO)者占比、SYNTAX积分高于无T2DM组,植入支架长度长于无T2DM组(P<0.05)。T2DM组患者IR后36个月内心源性死亡率、心肌梗死发生率、再次血运重建率、支架内血栓形成发生率、再次住院率及大出血发生率高于无T2DM组(P<0.05)。结论与未合并T2DM的女性冠心病MVD患者相比,合并T2DM的女性冠心病MVD患者冠状动脉病变更复杂,IR后严重并发症发生风险及疾病复发风险较高,预后更差。

Background Type 2 diabetes mellitus(T2DM)is an equal risk of coronary heart disease.About 80%of T2DM patients died from cardiovascular disease.At present,there are few reports on the impact of T2DM on the prognosis of female coronary heart disease patients with multivessel disease(MVD).Objective To investigate the impact of T2DM on prognosis after incomplete revascularization(IR)in female coronary artery disease patients with MVD.Methods A total of 638 female coronary heart disease patients with MVD who underwent IR in Affiliated People's Hospital of Zhengzhou,the Second School of Clinical Medicine,Southern Medical University from 2010 to 2017 were selected and divided into T2DM group(n=122)and non-T2DM group(n=516)according to the presence or absence of T2DM.The clinical data,characteristics of coronary artery lesion,incidence of cardiovascular events during hospitalization and within 36 months after IR were compared between the two groups.Results The proportion of patients with three vessel lesions of MVD type,patients with left main artery of lesion site,patients with chronic total coronary occlusion(CTO)and SYNTAX score in T2DM group were higher than those in non-T2DM group,and the length of implanted stent was longer than that in non-T2DM group(P<0.05).The cardiogenic mortality,incidence of myocardial infarction,revascularization rate,incidence of stent thrombosis,rehospitalization rate and incidence of massive hemorrhage in T2DM group were higher than those in non-T2DM group within 36 months after IR(P<0.05).Conclusion Compared with female coronary heart disease patients with MVD without T2DM,female T2DM patients with coronary heart disease with MVD have more complex coronary artery lesions,higher risk of serious complications and disease recurrence after IR,and worse prognosis.