冠心病合并糖尿病患者药物洗脱支架置入术后远期疗效观察

摘要

Objective To analyze the long-term effect and safety of drug-eluting stent in patients with coronary heart disease (CHD) accompanying diabetes mellitus (DM). Methods Six hundred and forty-six patients who underwent drug-eluting stenting in our hospital from January 2005 to December 2008 were divided into CHD with DM group (n=192) and CHD without DM group (n=454) . Of the 192 patients in CHD with DM group, 183 (95.3%) were followed up. Of the 454 patients in CHD without DM group, 428 (94.3%) were followed up. The incidence of major adverse cardiac events (MACE) was recorded in these followed up patients after drug-eluting stenting. Results The incidence of hypertension and lesions of 3 coronary branches was higher in CHD with DM group than in CHD without DM group (75.4%vs 60.5%, P=0.00;47.0%vs 37.6%, P=0.05). The proportion of female patients was higher in CHD with DM group than in CHD without DM group (26.2%vs 16.6%, P=0.01). The average age of CHD with DM group was younger than that of CHD without DM group 60.08±11.58 years vs 64.01±10.79 years, P=0.00). No significant difference was found in the incidence of MACE between the two groups. However, the incidence of MACE tended to increase with the time after operation in the two groups. The incidence of stent thrombosis was higher in CHD with DM group than in CHD without DM group (2.7%vs 0.2%, P=0.02). Conclusion The proportion of patients with CHD accompanying DM is higher than that of those not accompanying DM. The incidence of stent thrombosis is higher in patients with CHD accompanying DM than in those not accompanying DM. The incidence of MACE tends to increase after drug-eluting stenting, especially after 5 years.%　　目的分析冠心病合并糖尿病患者药物洗脱支架(drug-eluting stent，DES)置入后远期有效性及安全性。方法在本院心内科2005年1月-2008年12月间行冠状动脉造影确诊为冠心病并行DES支架置入的646例患者根据有无合并糖尿病分为DES糖尿病组192例(随访183例，95.3%)与DES非糖尿病组454例(随访428例，94.3%)，随访患者在DES置入后远期不良心血管事件(major adverse cardiac events，MACE)发生情况。结果糖尿病组合并高血压(75.4%vs 60.5%，P=0.00)及冠状动脉三支病变(47.0%vs 37.6%，P=0.05)、女性(26.2%vs 16.6%，P=0.01)比例高于非糖尿病组，单支病变(24.0%vs 32.0%，P=0.05)比例及平均年龄小于非糖尿病组(60.08±11.58 vs 64.01±10.79，P=0.00)。两组MACE发生率比较差异无统计学意义，但随着术后时间延长，两组MACE率均呈递增趋势。两组支架内血栓发生率差异有统计学意义(2.7%vs 0.2%， P=0.02)。结论冠心病合并糖尿病患者较单纯冠心病患者多支病变比例及PCI术后确定的支架内血栓发生率高。DES术后两组MACE发生率均呈递增趋势，糖尿病组在极远期(＞5年)增长更快。