糖调节受损对冠状动脉介入治疗患者预后的影响

摘要

Objective To study the incidence of 6 months cardiovascular events in coronary heart disease patients ( including unstable angina, stable angina, acute ST segment elevation myocardial infarction, acute non-ST segment elevation myocardial infarction ) with impaired glucose regulation, which underwent percutaneous coronary intervention ( PCI). Methods From September 2008 to September 2010,206 patients underwent PCI were randomly divided into four groups, the diabetic group ( A group, n =70 ), impaired fasting glucose group ( B group, n =36 ), impaired glucose tolerance group ( C group, n = 35 J, and non-impaired glucose regulation group or normal blood glucose group 1_) group, n =65 ). Ihe coronary angio-graphic were re-performed and compared, and short term prognosis was evaluated. Results The re-performed coronary angiog-raphy displayed that the incidences of the three branches lesion, left main stem lesion, C-type lesions were more in group A , B, C than those of in the D group ( P < 0. 05 ). The cardiac ultrasound at 6 months displayed that the EF values has no difference among four groups ( P >0. 05 ). Symptoms of patients with angina initial screening exercise test results are shown; A, B, C group exercise test results positive difference compared with the D group ( P < 0. 05 ), while there was no difference among the A, B, C groups( P >0. 05). Four groups of patients with positive exercise test in patients with coronary angiogra-phy reviewed that the rate of re-stenosis rate was higher in A, B, C group than that in the D group ( P < 0. 05 ), also the incidence of new cardiovascular events ( P <0. 05 ). Biochemical indexes of HbAlc in A,B,C groups were higher than that of in the D group ( P < 0. 05 ). Conclusion Impaired glucose regulation and type 2 diabetes have similar effect on vascular damage, and it was important to detect blood sugar abnormality as well as early intervention.%目的 研究冠心病(包括不稳定性心绞痛、稳定性心绞痛、急性ST段抬高型心肌梗死、急性非ST段抬高型心肌梗死患者)合并糖调节受损及糖尿病患者,在行冠状动脉介入(PCI)治疗后6个月发生的心血管事件.方法 将2008年9月-2010年9月行PCI治疗的患者206例,随机分成4组,糖尿病组(A组)70例、空腹血糖受损组(B组)36例、糖耐量减低组(C组)35例、非糖调节受损组或正常血糖组(D组)65例.对4组冠状动脉造影结果进行比较;部分患者复查冠状动脉造影等,对近期预后进行评估.结果 冠状动脉造影结果比较,A、B、C组冠状动脉三支病变、左主干病变、C型病变均多于D组(P＜0.05);心功能方面,6个月时心脏超声测EF值,结果示:A、B、C、D 组之间比较无差异(P＞0.05).对有心绞痛症状的患者进行运动试验初步筛选,A、B、C组运动试验结果阳性发生率与D组比较有差异(P＜0.05),而A、B、C组之间比较无差异(P＞0.05).4组患者中对运动试验阳性的患者复查冠状动脉造影,A、B、C组支架内再狭窄发生率高于D组(P＜0.05);A、B、C组新出现其他血管病变的发生率高于D组(P＜0.05).A、B、C组HbA1c高于D组,差异有统计学意义(P<0.05).结论 糖调节受损与2型糖尿病有类似血管损害,早期发现血糖异常、尽早干预血糖对PCI患者预后非常重要.