糖尿病对无保护左冠状动脉主干病变患者不同血运重建术的影响  

Influence of diabetes on different revascularizations in patients with unprotected left main coronary artery disease

作　　者：吴长燕[1] 玉献鹏[1] 陈方[1] 吕树铮[1] 苑飞[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029

出　　处：《中国循证心血管医学杂志》2016年第3期283-286,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：首都医学发展科研基金(2009-2074)

摘　　要：目的 探讨糖尿病对经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）治疗无保护左冠状动脉主干（左主干）病变的影响是否存在差异。方法 回顾性分析北京安贞医院2003年1月~2007年7月间入院明确诊断冠状动脉粥样硬化性心脏病（冠心病）患者922例,其按治疗方式不同分组,PCI使用药物洗脱支架（DES）与CABG治疗无保护左主干病变患者（PCI组465例,CABG组457例）,分别在糖尿病人群中和无糖尿病人群中比较PCI和CABG两组间死亡、心肌梗死、再次血运重建等不良事件发生率。结果 随访中位数7.1年,多因素校正后无论是否合并糖尿病,PCI和CABG两组死亡率（合并糖尿病P=0.41;非糖尿病P=0.25）及死亡、心肌梗死、卒中联合终点发生风险（合并糖尿病HR=0.79,P=0.40;非糖尿病HR=0.82,P=0.35）无统计学差异,PCI组再次血运重建发生率显著高于CABG组（糖尿病HR=2.11,P=0.02;非糖尿病HR=2.37,P〈0.001）,而CABG组卒中发生风险显著高于PCI组（糖尿病HR=0.23,P=0.02;非糖尿病HR=0.40,P=0.02）。结论 糖尿病在治疗无保护左主干病变血运重建策略选择中不是独立影响因素。Objective To discuss the influence of diabetes on percutaneous coronary intervention （PCI） or coronary artery bypass grafting （CABG） in treatment of unprotected left main coronary artery （LMCA） disease. Methods The data of patients with coronary heart disease （CHD） was analyzed retrospectively from Jan. 2003 to Jul. 2007, and the patients （n=922） were divided into PC1 group （n=465） and CABG group （n=457） according to therapies. The incidence of adverse events, including death, myocardial infarction and re-revascularization, were compared between 2 groups and diabetic group and non-diabetic group respectively. Results The follow-up median was 7.1 y. After adjusting with multiple factors, PCI group and CABG group, whether or not patients with diabetes, had no statistical difference in mortality （P=0.41 in diabetic gToup, P=0.25 in non-diabetic group）, and in risks of death, myocardial infarction and stroke （HR=0.79, P=0.40 in diabetic group, HR=0.82, P=0.35 in non- diabetic group）. The incidence of re-revascularization was significantly higher in PCI group than that in CABG group （HR=2.11, P=0.02 in diabetic group, HR=2.37, P〈0.001 in non-diahetic group）. The risk of stroke was significantly higher in CABG group than that in PCI group （HR=0.23, P=0.02 in diabetic group, HR=0.40, P=0.02 in non-diabetic group）. Conclusion Diabetes is not an independent influencing factor on revascularization strategies selection in treatment of unprotected LMCA disease.

关 键 词：无保护左冠状动脉主干病变 糖尿病 冠状动脉旁路移植术 经皮冠状动脉介入术 

分 类 号：R587.1[医药卫生—内分泌]