血糖控制方式对冠心病并2型糖尿病患者经皮冠状动脉介入治疗后预后的影响研究

摘要

目的 探讨血糖控制方式对冠心病并2型糖尿病(T2DM)患者经皮冠状动脉介入治疗(PCI)后预后的影响.方法 选取2014年12月—2016年1月于郑州人民医院心内科行PCI的冠心病并T2DM患者303例,根据预后情况分为预后良好组214例与预后不良组89例,根据血糖控制方式分为单纯饮食控制组42例、胰岛素治疗组75例、口服药物治疗组186例.比较不同血糖控制方式患者主要心血管不良事件(MACE)发生情况,冠心病并T2DM患者PCI后预后的影响因素分析采用多因素Logistic回归分析.结果 单纯饮食控制组、胰岛素治疗组、口服药物治疗组患者复发心绞痛、非致死性心肌梗死发生率比较,差异有统计学意义(P＜0.05);单纯饮食控制组、胰岛素治疗组、口服药物治疗组患者全因死亡率、靶血管血运重建发生率比较,差异无统计学意义(P＞0.05).预后良好组与预后不良组患者性别、年龄、吸烟史、高血压发生率、高脂血症发生率、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)比较,差异无统计学意义(P＞0.05);预后良好组患者急性冠脉综合征发生率、三酰甘油(TG)、空腹血糖、糖化血红蛋白(HbA1c)、C反应蛋白(CRP)低于预后不良组(P＜0.05).多因素Logistic回归分析结果显示,急性冠脉综合征[OR=5.119,95％CI (1.256,6.428)]、TG[OR=2.257,95％ CI(1.055,4.828)]、空腹血糖[OR=3.074,95％CI(1.521,6.213)]、HbA1.[OR=5.376,95％ CI (2.777,10.407)]、CRP[OR=5.853,95％CI (2.442,14.029)]、血糖控制方式[OR=5.830,95％CI (2.564,13.253)]是冠心病并T2DM患者PCI后预后的影响因素(P＜0.05).结论 血糖控制方式是冠心病并T2DM患者PCI后预后的影响因素.%Objective To investigate the impact of blood glucose control mode on prognosis in postoperative coronary heart disease patients complicated with type 2 diabetes mellitus (T2DM) treated by PCI.Methods From December 2014 to January 2016,a total of 303 coronary heart disease patients complicated with T2DM were selected in the Department of Cardiology,the People's Hospital of Zhengzhou,all of them received PCI and they were divided into A group (with good prognosis,n =214) and B group (with poor prognosis,n =89) according to the prognosis,into C group (received simple diet control,n =42),D group (received insulin treatment,n =75) and E group (received oral medication,n =186) according to the blood glucose control modes.Incidence of MACE was compared in patients with different blood glucose control modes,and influencing factors of prognosis in postoperative coronary heart disease patients complicated with T2DM treated by PCI were analyzed by multivariate Logistic regression analysis.Results There were statistically significant differences of incidence of recurrent angina pectoris and non-fatal myocardial infarction among C group,D group and E group (P ＜ 0.05),while no statistically significant differences of incidence of all-cause mortality or incidence of target vessel revascularization was found among C group,D group and E group (P ＞0.05).No statistically significant differences of gender,age,smoking history,incidence of hypertension or hyperlipidaemia,TC,LDL-C or HDL-C was found between A group and B group (P ＞ 0.05);incidence of ACS,TG,FPG,HbA1c and CRP of A group were statistically significantly lower than those of B group (P ＜ 0.05).Multivariate Logistic regression analysis results showed that,ACS [OR =5.119,95％ CI (1.256,6.428)],TG [OR=2.257,95％CI (1.055,4.828)],FPG [OR=3.074,95％CI (1.521,6.213)],HbA1c [OR=5.376,95％CI (2.777,10.407)],CRP [OR =5.853,95％ CI (2.442,14.029)] and blood glucose control mode [OR =5.830,95％ CI (2.564,13.253)] were influencing factors of prognosis in postoperative coronary heart disease patients complicated with T2DM treated by PCI (P ＜ 0.05).Conclusion Blood glucose control mode is one of influencing factors of prognosis in postoperative coronary heart disease patients complicated with T2DM treated by PCI.