2型糖尿病对冠心病合并射血分数保留心力衰竭患者的预后研究

Effect of type 2 diabetes mellitus on the prognosis of patients with coronary heart disease complicated with heart failure with preserved ejection fraction

目的探讨2型糖尿病对冠心病合并射血分数保留心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者的预后影响。方法采用回顾性研究的方法,连续纳入2017年1月至2017年12月就诊于新疆医科大学第一附属医院心脏中心的患者,将根据心脏超声结果、冠状动脉造影术结果确诊的393例冠心病合并射血分数保留心力衰竭患者,再按是否患有糖尿病,分为糖尿病组和非糖尿病组,比较2组主要心血管不良事件(major adverse cardiovascular events,MACE)的发生率。根据是否完全血运重建,比较完全血运重建组和非完全血运重建组MACE的发生率,采用多因素COX回归分析影响预后的危险因素。结果糖尿病组的高血压患病率、ACEI/ARB类药物使用率高于非糖尿病组(P<0.05),而高密度脂蛋白水平低于非糖尿病组(P<0.05)。糖尿病组MACE的发生率(35.8%)较非糖尿病组(25%)高(P=0.027),完全血运重建同时能改善糖尿病组和非糖尿病组患者的预后,降低MACE发生率(P<0.05)。多因素COX回归分析结果显示,心肌梗死病史[HR=0.44,95%CI(0.20,1.00),P=0.049]、未完全血运重建[HR=17.28,95%CI(2.34,127.43),P=0.005]、射血分数[HR=0.90,95%CI(0.82,1.00),P=0.046]均是影响冠心病合并射血分数保留心力衰竭患者预后的主要因素。结论2型糖尿病影响冠心病合并射血分数保留心力衰竭患者的预后,完全血运重建可改善2型糖尿病伴冠心病射血分数保留心力衰竭患者的预后。

Objective To investigate the effect of type 2 diabetes mellitus on the prognosis of coronary heart disease patients who had a complication of heart failure with preserved ejection fraction.Metohds A retrospective study was performed with 393 coronary heart disease patients who were complicated with heart failure with preserved ejection fraction.The diagnosis was based on the results of echocardiography and coronary angiography at the heart center of the First Affiliated Hospital of Xinjiang Medical University assessed from January 2017 to December 2017.The patients were divided into diabetic group and non-diabetic group.The incidence of major adverse cardiovascular events(MACE)was compared between the two groups.In addition,the incidence of MACE was compared between the complete revascularization group and the incomplete revascularization group.Multivariate Cox regression analysis was used to analyze the effect of the risk factors on prognosis.Results The prevalence of hypertension and the use of ACEi/ARB in the diabetic group were higher than those in the non-diabetic group(P<0.05),and the level of high-density lipoprotein in the diabetic group was lower than that in the non-diabetic group(P<0.05).The incidence of MACE in the diabetic group(35.8%)was higher than that in non-diabetic group(25%,P=0.027).Complete revascularization improved the prognosis and reduced the incidence of MACE in both the diabetic group and non-diabetic group(P<0.05).Multivariate Cox regression analysis showed that a history of myocardial infarction(HR=0.44,95%CI 0.20 to 1.00,P=0.049),incomplete revascularization(HR=17.28,95%CI 2.34 to 127.43,P=0.005),and ejection fraction(HR=0.90,95%CI 0.82 to 1.00,P=0.046)were associated with the occurrence of MACE in patients with coronary heart disease complicated with heart failure with preserved ejection fraction.Conclusion Type 2 diabetes mellitus affects the prognosis of coronary heart disease patients who have complication of heart failure with preserved ejection fraction.Complete revascularization can improve the prognosis of type 2 diabetic patients with coronary heart disease who have complications of heart failure with preserved ejection fraction.