2型糖尿病对冠心病合并射血分数保留心力衰竭患者的预后研究  

Effect of type 2 diabetes mellitus on the prognosis of patients with coronary heart disease complicated with heart failure with preserved ejection fraction

作　　者：陈蓉[1] 于子翔[1] 李芊 董佳佳 娜孜拉·亚利钦 关丽娜[4] 李晓梅[1] 马依彤[5] CHEN Rong;YU Zixiang;LI Qian;DONG Jiajia;YALIQIN Nazila;GUAN Lina;LI Xiaomei;MA Yitong(First Department of Coronary Heart Disease,Heart Center of the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,P.R.China;Cardiology Department of Pingmei Shenma Medical Group General Hospital,Pingdingshan 467000,P.R.China;Cardiology Department of Xingjiang Bozhou People’s Hospital,Bole 833400,P.R.China;Cardiac Ultrasound Diagnosis Department of the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,P.R.China;Heart Center of the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,P.R.China)

机构地区：[1]新疆医科大学第一附属医院心脏中心冠心病一科,乌鲁木齐830054 [2]平煤神马医疗集团总医院心内科,河南平顶山市467000 [3]新疆博州人民医院心内科,新疆博乐833400 [4]新疆医科大学第一附属医院心脏超声诊断科,乌鲁木齐830054 [5]新疆医科大学第一附属医院心脏中心,乌鲁木齐830054

出　　处：《中国循证医学杂志》2022年第5期517-523,共7页Chinese Journal of Evidence-based Medicine

基　　金：新疆重大疾病医学重点实验室开放课题项目(编号:SKLIB-XJMDR-2012-Y1)。

摘　　要：目的探讨2型糖尿病对冠心病合并射血分数保留心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者的预后影响。方法采用回顾性研究的方法,连续纳入2017年1月至2017年12月就诊于新疆医科大学第一附属医院心脏中心的患者,将根据心脏超声结果、冠状动脉造影术结果确诊的393例冠心病合并射血分数保留心力衰竭患者,再按是否患有糖尿病,分为糖尿病组和非糖尿病组,比较2组主要心血管不良事件(major adverse cardiovascular events,MACE)的发生率。根据是否完全血运重建,比较完全血运重建组和非完全血运重建组MACE的发生率,采用多因素COX回归分析影响预后的危险因素。结果糖尿病组的高血压患病率、ACEI/ARB类药物使用率高于非糖尿病组(P<0.05),而高密度脂蛋白水平低于非糖尿病组(P<0.05)。糖尿病组MACE的发生率(35.8%)较非糖尿病组(25%)高(P=0.027),完全血运重建同时能改善糖尿病组和非糖尿病组患者的预后,降低MACE发生率(P<0.05)。多因素COX回归分析结果显示,心肌梗死病史[HR=0.44,95%CI(0.20,1.00),P=0.049]、未完全血运重建[HR=17.28,95%CI(2.34,127.43),P=0.005]、射血分数[HR=0.90,95%CI(0.82,1.00),P=0.046]均是影响冠心病合并射血分数保留心力衰竭患者预后的主要因素。结论2型糖尿病影响冠心病合并射血分数保留心力衰竭患者的预后,完全血运重建可改善2型糖尿病伴冠心病射血分数保留心力衰竭患者的预后。Objective To investigate the effect of type 2 diabetes mellitus on the prognosis of coronary heart disease patients who had a complication of heart failure with preserved ejection fraction.Metohds A retrospective study was performed with 393 coronary heart disease patients who were complicated with heart failure with preserved ejection fraction.The diagnosis was based on the results of echocardiography and coronary angiography at the heart center of the First Affiliated Hospital of Xinjiang Medical University assessed from January 2017 to December 2017.The patients were divided into diabetic group and non-diabetic group.The incidence of major adverse cardiovascular events(MACE)was compared between the two groups.In addition,the incidence of MACE was compared between the complete revascularization group and the incomplete revascularization group.Multivariate Cox regression analysis was used to analyze the effect of the risk factors on prognosis.Results The prevalence of hypertension and the use of ACEi/ARB in the diabetic group were higher than those in the non-diabetic group(P<0.05),and the level of high-density lipoprotein in the diabetic group was lower than that in the non-diabetic group(P<0.05).The incidence of MACE in the diabetic group(35.8%)was higher than that in non-diabetic group(25%,P=0.027).Complete revascularization improved the prognosis and reduced the incidence of MACE in both the diabetic group and non-diabetic group(P<0.05).Multivariate Cox regression analysis showed that a history of myocardial infarction(HR=0.44,95%CI 0.20 to 1.00,P=0.049),incomplete revascularization(HR=17.28,95%CI 2.34 to 127.43,P=0.005),and ejection fraction(HR=0.90,95%CI 0.82 to 1.00,P=0.046)were associated with the occurrence of MACE in patients with coronary heart disease complicated with heart failure with preserved ejection fraction.Conclusion Type 2 diabetes mellitus affects the prognosis of coronary heart disease patients who have complication of heart failure with preserved ejection fraction.Complete revascularizati

关 键 词：2型糖尿病 射血分数保留心力衰竭 冠状动脉粥样硬化性心脏病 预后 

分 类 号：R541.4[医药卫生—心血管疾病] R587.1[医药卫生—内科学] R541.6[医药卫生—临床医学]