急性心肌梗死患者中糖尿病人群的临床特点及随访研究

摘要

目的 研究糖尿病急性心肌梗死患者的临床特点,比较糖尿病和非糖尿病患者急性心肌梗死后4～5年预后情况.方法 经过一定纳排标准收入420例急性心肌梗死患者,分为糖尿病组161人,非糖尿病组259人,对两组患者的基线资料、病情资料、短期转归及长期预后情况进行对比分析.结果 与非糖尿病组相比,糖尿病组患者年龄偏大(65.65±11.33 vs.63.30±15.34)、男性比例偏低(64.59％ vs.79.92％)、合并高血压病比例(64.60％ vs.53.28％)和高脂血症比例(42.24％ vs.26.25％)等偏高;三支病变比例(59.29％ vs.40.83％)和建议冠脉旁路移植术者(11.11％ v.5.31％)比例偏高;短期转归方面两组患者没有明显差异,但长期随访结果显示糖尿病组患者不良心血管事件发生概率(50.67％ vs.27.72％)和全因死亡率(20.00％ vs.9.90％)均高于非糖尿病组.结论 糖尿病对急性心肌梗死患者的病情及预后有显著的负面影响,主要表现为病变范围和程度的严重性以及长期预后中主要不良心血管事件的风险增加.%Objective To investigate the clinical characteristics of diabetic patients combined with acute myocardial infarction (AMI) and to compare the prognosis between diabetic and non-diabetic patients in 4-5 years after the onset of AMI.Methods Followed the certain inclusive and exclusive criteria,a total of 420 patients with acute myocardial infarction were included and divided into diabetes group (group D) and non-diabetes group (group N) with numbers as 161 people and 259 respectively.Baseline data,clinical information,short-term outcome and long-term prognosis of the two groups were compared and analyzed.Results Among the patients with diabetes,the average age was older (65.65 ± 11.33 vs.63.30 ± 15.34),with fewer males (64.59％ vs.79.92％);and more likely to have other complications as hypertension (64.60％ vs.53.28％) or hyperlipidemia (42.24％ vs.26.25％).59.29％ of the patients in group D showed pathological changes in 3 major coronary arteries,which were significantly more than its counterpart (40.83％).The proportion of patients that had undergone the coronary artery bypass,grafting (11.11％ vs.5.31％) appeared also higher.There was no significant difference seen in the short-term outcomes between the two groups,but results from the long-term follow-up program showed that both the incidence of Major Adverse Cardiovascular Events (MACE) (50.67％ vs.27.72％) and the all-cause mortality (20.00％ vs.9.90％) in group D were higher than those appeared in group N (27.72％).Conclusions Patients suffered from the combination of both diabetes and acute myocardial infarction appeared older in age,more in females,with more complications and the coronary artery lesions were more severe and wider.During hospitalization,no significant difference was seen regarding the short-term outcomes between the two groups but the results from long-term follow-up process showing that the risk of MACE events was significantly higher in patients with type2 diabetes.