急性冠状动脉综合征合并2型糖尿病患者的临床随访研究

摘要

Objective To investigate the incidence of adverse cardiovascular events in patients with acute coronary syndrome ( ACS) and type 2 diabetes mellitus ( DM) .Methods Five hudred and sixty-eight patients with ACS diagnosed in PLA General Hospital from April 2007 to April 2008 were divided into ACS with diabetes mellitus group ( n =125 ) and ACS without diabetes group ( n =443).Collected the clinical data and follow-up questionnaires and follow-up study for end point of adverse cardiovascular events ( including angina , myocardial infarction , cardiogenic shock , cardiac death , target vessel re-vascularization and stent thrombosis ) , comparative analysis of clinical features and prognosis of ACS patients with type 2 dia-betes group and ACS without type 2 diabetic patients.Results The median follow-up time was 8 years, with a median follow-up of 7.3 years.A total of 546 cases (96.13%) patients completed follow-up, ACS with diabetes group MACE was higher than patients without diabetes group (44.8%vs.14.3%,χ2 =10.876, P =0.035), Cox regression analysis showed that age, fasting blood glucose were significant risk of adverse cardiovascular events predictor ( OR =1.003, 95%CI1 .001-1.031, OR =1.533, P =00.38 ;95%CI 1.131-2.077, P =0.012).Conclusions Patients with ACS complicated with type 2 diabetes mellitus are at high risk of major adverse cardiac events .Fasting plasma glucose is a predictor of MACE .%目的：探讨急性冠状动脉综合征（ ACS）合并2型糖尿病患者临床不良心血管事件发生率和影响临床预后的危险因素。方法纳入2007年4月—2008年4月解放军总医院确诊的ACS患者568例，根据有无合并2型糖尿病分为ACS合并2型糖尿病组（ n ＝125）与ACS未合并2型糖尿病组（ n ＝443）。搜集相关临床资料，并进行随访问卷调查，随访研究终点为不良心血管事件（包括心绞痛、心肌梗死、心源性休克、心源性死亡、靶血管血运重建和支架内血栓），比较分析ACS合并2型糖尿病组与ACS未合并2型糖尿病组患者的临床特点和预后差异。结果随访时间为7～8年，中位随访时间为7．3年。共有546例（96．13％）患者完成随访，ACS合并糖尿病组MACE发生率高于未合并糖尿病组（44．8％vs．14．3％，χ2＝10．876， P ＝0．035），Cox多元回归分析年龄、空腹血糖是不良心血管事件的显著危险预测因子（ OR ＝1．003，95％CI 1．001～1．031， P ＝0．038；OR ＝1．533，95％CI 1．131～2．077， P ＝0．012）。结论 ACS合并2糖尿病患者不良心血管事件发生率高，年龄和空腹血糖是MACE危险预测因子。