冠心病合并2型糖尿病患者冠状动脉介入治疗预后危险因素分析  

Analyse the predictors of prognosis in patients with diabetes mellitus undergoing percutaneous coronary intervention with drug-eluting stent

作　　者：冯仕勇[1] 许勇[1] 何芙蓉 刘茂兰 王建龙[2] 王志坚[2] FENG Shiyong;XU Yong;HE Furong;LIU Maolan;WANG Jianlong;WANG Zhijian(Department ofCardiology,The Second People's Hospital of Deyang,Deyang 618000,China)

机构地区：[1]四川德阳市第二人民医院心内科,618000 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内12病房

出　　处：《心肺血管病杂志》2020年第9期1040-1044,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探究冠心病合并2型糖尿病患者经皮冠状动脉介入治疗(PCI)术后的危险因素,从而针对性采取措施预防不良事件。方法:入选2013年1月至2015年12月期间2356例行PCI的2型糖尿病患者,随访4年。临床终点为主要的心脑血管不良事件(MACCE),包括心源性死亡、心肌梗死、重复血运重建或卒中。根据预后MACCE将患者分为两组,采用COX多因素比例风险回归模型对人群的预后进行分析,并采用多个模型验证。结果:平均随访时间为47.50个月,MACCES事件总发生率为20.5%。COX多因素分析提示血浆致动脉硬化指数(AIP)是影响2型糖尿病患者PCI预后的独立危险因素(HR=1.528,95%CI:1.100~2.123,P=0.011)。结论:AIP可以作为2型糖尿病患者血脂管理的综合指标,影响着PCI的预后。高水平AIP的2型糖尿病患者MACCES事件更多。建议采用AIP对2型糖尿病患者PCI术后的血脂进行管理,建议AIP不高于0.318。Objective:To explore the risk factors of patients with type 2 diabetes mellitus after percutaneous coronary intervention,so as to take targeted measures to prevent adverse events.Methods:We collected 2356 patients with type 2 diabetes who underwent percutaneous coronary intervention from January 2013 to December 2015,and followed up for 4 years.The primary outcome was major cardiovascular and cerebrovascular adverse events(MACCE),which were considered to be the combined outcome of cardiogenic death,myocardial infarction,repetitive revascularization,or stroke.Patients were divided to two groups according to MACES.COX multivariate proportional risk regression model was used to analyze the prognosis of the population.Results:The mean follow-up time was 47.50 months,and the total incidence of MACCES events was 20.5%.COX multivariate analysis before population matching suggested that AIP was an independent risk factor for the prognosis of percutaneous coronary intervention in type 2 diabetes(HR=1.528,95%CI:1.100-2.123,P=0.011).Conclusions:Atherogenic Index of Plasma(AIP)is a comprehensive index of blood lipid management in type 2 diabetes patients and affects the prognosis of PCI.MACCES events were more common in type 2 diabetic patients with high levels of AIP.It is suggested that AIP should be used for blood lipid management in patients with type 2 diabetes after PCI,and AIP should not be higher than 0.318.

关 键 词：血浆致动脉硬化指数 2型糖尿病 经皮冠状动脉介入治疗 主要心脑血管不良事件 

分 类 号：R54[医药卫生—心血管疾病]