2型糖尿病血糖控制不良合并急性心肌梗死患者择期经皮冠状动脉介入治疗后冠状动脉微循环及近期预后  

Coronary microcirculation and short-term prognosis in patients with type 2 diabetes and poor glucose controls who underwent elective percutaneous coronary intervention for acute myocardial infarction

作　　者：李萌玫 邵一兵[1] 张纯全[1] 刘玉昊[1] 武越[1] 王旭[1] 

机构地区：[1]青岛大学附属青岛市市立医院心内科,山东青岛266011

出　　处：《中国介入心脏病学杂志》2017年第11期628-633,共6页Chinese Journal of Interventional Cardiology

摘　　要：目的比较2型糖尿病血糖控制不良与非2型糖尿病合并急性心肌梗死行择期经皮冠状动脉介入治疗(PCI)术后冠状动脉微循环的差异和近期预后。方法根据患者病史及糖化血红蛋白情况将患者分为2型糖尿病组(24例)和非2型糖尿病组(32例),比较两组患者的基本临床资料、冠状动脉造影结果、冠状动脉(罪犯血管)的微循环阻力指数(IMR)和PCI术后即刻及术后3个月左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)的变化,比较两组PCI术后3个月主要不良心血管事件(MACE)发生率,对糖尿病和LVEF恢复情况进行风险评估。结果 (1)两组患者一般资料及术前生化指标比较,差异均无统计学差异(均P>0.05)。2型糖尿病组患者血糖[(9.4±3.6)mmol/L比(6.1±2.5)mmol/L,P<0.010],糖化血红蛋白[(8.4±0.6)%比(5.7±0.9)%,P<0.010],微循环阻力指数[(29.12±7.45)比(22.74±6.87),P=0.011]显著高于非2型糖尿病组,差异均有统计学意义。(2)冠状动脉造影显示,两组患者冠状动脉病变部位,冠状动脉病变支数比较,差异均无统计学差异(均P>0.05)。(3)两组患者术后即刻LVEDD和LVEF比较,差异均无统计学差异(均P>0.05)。2型糖尿病组PCI术后3月LVEDD[(52.3±4.8)mm比(48.6±5.1)mm,P=0.019],LVEDD增加值[(4.1±6.3)mm比(0.8±4.4)mm,P=0.005]显著高于非2型糖尿病组,差异有统计学意义,但是LVEF[(48.6±7.3)%比(56.1±4.7)%,P=0.003],LVEF增加值[(–1.9±6.8)%比(4.3±5.4)%,P=0.007]显著低于非2型糖尿病组,差异均有统计学意义。(4)两组患者均未发生死亡病例。2型糖尿病组术后3月再发心肌梗死发生率[16.7%比3.1%,P=0.043],心肌梗死相关血管再次血运重建率[20.8%比6.3%,P=0.049],MACE发生率[37.5%比9.4%,P=0.018]均显著高于非2型糖尿病组,差异均有统计学意义。(5)对糖化血红蛋白与IMR进行Pearson相关性分析,糖化血红蛋白与IMR呈正相关(r=0.324,P=0.048)。糖化血红蛋白与PCI术后3月LVEDD呈正相关(r=0.324,P=0.036),Objective To evaluate the status of microcirculation and to compare the short-term prognosis after elective PCI for AMI between patients with poorly controlled type2 diabetes and patients without type 2 diabetes. Methods According to the clinical history and HbAlc values, all patients were divided into 2 groups： diabetic group （group A, n=24） and non-diabetic group （group B, n=32）.Basic clinical data, left ventricular end diastolic diameter （LVEDD） and left ventricular shot ejection fraction （LVEF） immediately and 3 months after operation measured by echocardiography and the result of coronary angiography were compared between the two groups. The rate of MACE 3 months after PCI was also compared. A pressure-temperature sensor wire was used to measure the index of microcirculation resistance （IMR）immediately after PCI. Results 1.The mean IMR value in group A was higher than group B （29.12±7.45） vs. （22.74±6.87） ;P=0.011.The HbAlc levels has positive correlation with the IMR value （r=0.324; P=-0.048）. 2. The mean LVEDD and the mean LVEF Rad no significant difference between two groups before PCI. The mean LVEDD of group A at 3 months after PCI was significantly larger than group B （52.3±4.8）mm vs. （48.6±5.1）mm, P=0.019, the mean LVEF of group A 3 months post PCI was lower than that of group B（48.6±7.3） % vs. （56.1±4.7）%,P=-0.003. The mean increase in LVEDD at 3 months after PCI in group A was higher than group B （4.1±6.3）mm vs. （0.8±4.4）mm, p=0.005 and the mean increase in LVEF in group A was significantly lower than in group B （-1.9±6.8） % vs. （4.3±5.4） %, P=0.007. 3. HbA1c had positive correlation with LVEDD （r=0.324, p=0.048）and its increase at 3 months postoperatively （r=-0.422, P=-0.005）.4. Risk estimation found type 2 diabetes was an independent risk factor for poor recovery of LVEE The MACE rate was significantly higher in Group A than in Group B （35.7% vs. 9.4%, P=0.018）. Conclusions Patients with type2 diabetes were mor

关 键 词：糖尿病 微循环阻力指数 经皮冠状动脉介入治疗 预后 急性心肌梗死 

分 类 号：R542.22[医药卫生—心血管疾病] R587.1[医药卫生—内科学]