血糖水平对糖尿病合并冠心病患者CABG术后临床结局的影响

Impact of Blood Glucose Level on the Clinical Outcomes of Patients with Diabetes Mellitus Complicated with Coronary Heart Disease after CABG

目的探讨血糖水平对糖尿病合并冠心病患者冠状动脉旁路移植术(CABG)术后临床结局的影响。方法106例糖尿病合并冠心病患者均在体外循环下行CABG治疗,术后实施血糖控制,根据血糖控制效果分为控制理想组、控制良好组和控制不佳组,比较三组的心功能指标、不良心血管事件(MACE)和院内全因死亡发生率。绘制受试者工作特征(ROC)曲线分析血糖水平对MACE的预测价值。结果术后14 d,控制理想组LVEF高于控制良好组和控制不佳组,LVEDD低于控制良好组和控制不佳组(P<0.05)。控制理想组和控制良好组术后MACE、院内全因死亡发生率均低于控制不佳组(P<0.05)。ROC曲线分析结果显示,血糖水平对糖尿病合并冠心病患者CABG术后MACE有显著的预测价值(AUC=0.799,95%CI:0.678~0.919,P<0.001)。结论控制血糖水平有助于降低糖尿病合并冠心病患者CABG术后MACE和院内全因死亡发生率。

Objective To explore the impact of blood glucose level on the clinical outcomes of patients with diabetes mellitus complicated with coronary heart disease after coronary artery bypass grafting(CABG).Methods 106 patients with diabetes mellitus complicated with coronary heart disease were given CABG under cardiopulmonary bypass,and the blood glucose was controlled after operation.The patients were divided into ideal control group,good control group and poor control group according to the blood glucose control effect.The cardiac function indicators,and the incidences of major adverse cardiovascular events(MACE)and hospital all-cause death were compared among the three groups.The predictive value of blood glucose level on MACE was analyzed by drawing the ROC.Results 14 days after operation,the LVEF of the ideal control group was higher than that of the good control group and the poor control group,and the LVEDD was lower than that of the good control group and the poor control group(P<0.05).The incidences of postoperative MACE and hospital all-cause death in the ideal control group and the good control group were lower than those in the poor control group(P<0.05).ROC curve analysis results showed that the blood glucose level had significant predictive value for MACE after CABG in patients with diabetes mellitus complicated with coronary heart disease(AUC=0.799,95%CI:0.678-0.919,P<0.001).Conclusions Controlling blood glucose level is helpful to reduce the incidences of MACE and all-cause death in patients with diabetes mellitus complicated with coronary heart disease after CABG.