糖尿病急性心肌梗死患者的临床特点及随访研究-东南大学学报医学版

糖尿病急性心肌梗死患者的临床特点及随访研究

单位：1. 东南大学医学院,江苏南京 210009;
2. 东南大学附属中大医院,江苏南京 210009

分类号：R587.2

出版年·卷·期（页码）：2014·33·第二期（182-186）

摘要：

目的：探讨糖尿病急性心肌梗死患者的临床特点，分析植入药物洗脱支架后1年的随访情况。方法：将入选的350名急性心肌梗死患者分为两组，其中糖尿病组107人，非糖尿病组243人。所有患者均植入药物洗脱支架，对两组患者的临床危险因素及1年随访结果进行分析。结果：糖尿病组比非糖尿病组患者年龄大[(65.50±12.73)vs(60.80±14.38)岁,P=0.004]、男性比例少（58.5% vs 70.1%，P=0.012）、吸烟比例高（38.3% vs 24.3%，P=0.007），更易合并高血压病（84.1% vs 76.1%，P<0.001）、高脂血症（89.7% vs 79.0%，P=0.016）、慢性肾功能不全（24.3% vs 8.2%，P<0.001）等情况。糖尿病组比非糖尿病组3支病变比例高（41.1% vs 29.6%，P=0.035）、单支病变比例低（27.1% vs 44.4%，P=0.002）。糖尿病组主要心脏不良事件总的发生率高于非糖尿病组（19.6% vs 9.5%，P=0.008），其中全因性死亡是主导事件（13.1% vs 4.5%，P=0.004）。两组患者靶病变血运重建（4.7% vs 4.5%，P=0.952）、靶血管血运重建（12.1% vs 7.8%，P=0.195）、再次心肌梗死（1.9% vs 0.4%，P=0.173）、支架内再狭窄（2.8% vs 2.9%，P=0.968）、支架内血栓形成（1.9% vs 1.6%，P=0.882）的发生率没有显著差异。结论：糖尿病急性心肌梗死患者比非糖尿病急性心肌梗死患者平均年龄大，且女性、吸烟、高血压、高血脂、肾功能不全、3支病变的比例均高于后者，药物洗脱支架没有增加糖尿病急性心肌梗死患者再次心肌梗死、血运重建、支架内再狭窄、支架内血栓形成的发生率，但其主要心脏不良事件总的发生率比非糖尿病急性心肌梗死患者高，且主导事件是全因性死亡。

Objective: To evaluate the clinical characteristics of diabetic patients with acute myocardial infarction and the incidence of MACE after being treated with drugeluting stents. Methods: 350 patients who presented with acute myocardial infarction and were treated with drug-eluting stents were classified into 2 groups according to the presence or absence of DM. The clinical characteristics and one-year follow-up results in the two groups were analyzed. Results: The patients with DM were older than the patients without DM [(65.50±12.73)vs(60.80±14.38),P=0.004].The ratio of male patients was lower in the DM group (58.5% vs 70.1%,P=0.012)and the ratio of smoking(38.3% vs 24.3%,P=0.007),hypertension(84.1% vs 76.1%,P<0.001),hyperlipidemia(89.7% vs 79.0%,P=0.016),chronic renal insufficiency(24.3% vs 8.2%,P<0.001)was higher in the DM group. The incidence of multi-vessel disease was higher in the DM group (41.1% vs 29.6%,P=0.035),but the incidence of one-vessel disease was higher in the non-DM group (27.1% vs 44.4%,P=0.002). The incidence of composite MACE of one year was higher in the DM group (19.6% vs 9.5%,P=0.008).The incidence of death of one year was higher in the DM group(13.1% vs 4.5%,P=0.004). Conclusion: The DM patients with AMI is older and have higher ratio of female gender,smoking,hypertension,hyperlipidemia and chronic renal insufficiency than the non-DM patients with AMI; Compared to the non-DM patients with AMI,the DM patients with AMI show a preponderance of multi-vessel disease, the drug-eluting stent does not increase the incidence of myocardial infarction,target lesion revascularization,restenosis and stent thrombosis in the DM group. The incidence of composite MACE of one year is higher in the DM group, the all-case death are the dominant event.

参考文献：

[1] GRAG P,NORMAND S L,SILBAUGH T S,et al.Drug-eluting or bare-metal stenting in patients with diabetes mellitus:results from the Massachusetts Data Analysis Center Registry[J].Circulation,2008,118(22):2277-2285.
[2] MARESTA A,VARANI E,BALDUCELLI M,et al.Comparison of effectiveness and safety of sirolimus-eluting stents versus bare-metal stents in patients with diabetes mellitus (from the Italian Multicenter Randomized DESSERT Study)[J].Am J Cardiol,2008,101(11):1560-1566.
[3] LEE M S,JUREWITZ D,ZIMMER R,et al.Impact of diabetes and acute coronary syndrome on survival in patients treated with drug-eluting stents[J].Catheter Cardiovasc Interv,2008,72(7):909-914.
[4] ZHANG Q,SHEN J,ZHANG R Y,et al.Outcomes after primary coronary intervention with drug-eluting stent implantation in diabetic patients with acute ST elevation myocardial infarction[J].Chin Med J ,2007,120(21):1862-1867.
[5] MURCIA A M,HENNEKENS C H,LAMAS G A,et al.Impact of diabetes on mortality in patients with myocardial infarction and left ventricular dysfunction[J].Arch Intern Med,2004,164(20):2273-2279.
[6] LEE M S,JUREWITZ D,ZIMMER R,et al.Impact of diabetes and acute coronary syndrome on survival in patients treated with drug-eluting stents[J].Catheter Cardiovasc Interv,2008,72(7):909-914.
[7] ROZENMAN Y,SAPOZNIKOV D,GOTSMAN M S.Restenosis and progression of coronary disease after balloon angioplasty in patients with diabetes mellitus[J].Clin Cardiol,2000,23:890-894.
[8] MATHEW V,GERSH B J,WILLIAMS B A,et al.Outcomes in patients with diabetes mellitus undergoing percutaneous coronary intervention in the current era:a report from the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial[J].Circulation,2004,109(4):476-480.
[9] GOYAL A,MEHTA S R,GERSTEIN H C,et al.Glucose levels compared with diabetes history in the risk assessment of patients with acute myocardial infarction[J].Am Heart J,2009,157:763-770.
[10] LI L,GUO Y,GUO L,et al.The predictive value of admission glucose for the prognosis of AMI post primary percutaneous coronary intervention[J].Cardiovasc Revasc Med,2006,7:99.
[11] MIETTINEN H,LEHTO S,SALOMAA V,et al.Impact of diabetes on mortality after the first myocardial infarction.The FINMONICA Myocardial Infarction Register Study Group[J].Diabetes Care,1998,21:69-75.
[12] CARACCIOLO E A,CHAITMAN B R,FORMAN S A,et al.Diabetics with coronary disease have a prevalence of asymptomatic ischemia during exercise treadmill testing and ambulatory ischemia monitoring similar to that of non-diabetic patients[J].Circulation,1996,93:2097-2105.
[13] MAENG M,JENSEN L O,GALLOE A M,et al.Comparison of the sirolimus-eluting versus paclitaxel-eluting coronary stent in patients with diabetes mellitus:the diabetes and drug-eluting stent (DES) randomized angiography trial[J].Am J Cardiol,2009,103:345-349.
[14] DIBRA A,KASTRATI A,MEHILLI J,et al.ISAR-DIABETES Study Investigators.Paclitaxel-eluting or sirolimus-eluting stents to prevent restenosis in diabetic patients[J].N Engl J Med,2005,353:663-670.
[15] NIKOLSKY E,MEHRAN R,TURCOT D,et al.Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention[J].Am J Cardiol,2004,94:300-305.
[16] 左鹏飞,马根山.药物洗脱支架在急性心肌梗死治疗中的应用[J].现代医学,2012,40(5):621-624.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录