糖尿病合并左主干病变和(或)三支血管病变患者成功的经皮冠状动脉介入治疗对症状和生活质量的益处  

Symptoms and quality of life benefi ts of successful percutaneous coronary intervention in left main disease and/or 3-vessel disease patients with diabetes

作　　者：朱伯达 禹天同 韩鹏 张博辉[1] 张玺 袁平 王刚 杨易[5] 朱惠莉 孙盼盼 李彤彤 赵帅 李成祥[1] 廉坤 ZHU Bo-da;YU Tian-tong;HAN Peng;ZHANG Bo-hui;ZHANG Xi;YUAN Ping;WANG Gang;YANG Yi;ZHU Hui-li;SUN Pan-pan;LI Tong-tong;ZHAO Shuai;LI Cheng-xiang;LIAN Kun(Department of Cardiology,Xijing Hospital,Air Force Medical University,Xi’an 710032,China;Primary Flight Training Base,Air Force 2Aviation University,Harbin 150100,China;Department of Cardiology,No.981 Hospital of Joint Logistics Support Force,Chengde 067000,China;Department of General Medicine,Tangdu Hospital,Air Force Medical University,Xi’an 710032,China;Department of Cardiology,Air Force Hospital of Western Theater Command,Chengdu 610000,China)

机构地区：[1]中国人民解放军空军军医大学第一附属医院心血管内科,陕西西安710032 [2]空军航空大学初级飞行训练基地,黑龙江哈尔滨150100 [3]中国人民解放军联勤保障部队第九八一医院心内科,河北承德067000 [4]中国人民解放军空军军医大学第二附属医院全科医学科,陕西西安710032 [5]中国人民解放军西部战区空军医院心血管内科,四川成都610000

出　　处：《中国介入心脏病学杂志》2025年第2期93-100,共8页Chinese Journal of Interventional Cardiology

基　　金：西京医院医务人员培养助推项目(XJZT24LY39);空军军医大学临床研究项目(2022LC2208);陕西省重点研发计划重点产业创新链项目(2024SF-YBXM-004);陕西省重点研发计划一般项目(2024GXYBXM-136)。

摘　　要：目的 本研究旨在评估成功的经皮冠状动脉介入治疗(PCI)能否改善合并糖尿病的左主干病变和(或)三支血管病变患者的症状和生活质量。方法 连续纳入2018年4月1日至2021年5月31日在中国人民解放军空军军医大学第一附属医院行PCI的左主干病变和(或)三支血管病变患者,并将其分为糖尿病组和非糖尿病组。收集患者的基线资料、呼吸困难和心绞痛症状以及生活质量[分别采用Rose呼吸困难量表(RDS)和西雅图心绞痛量表(SAQ)、生命质量SF-12量表、欧洲五维健康量表(EQ-5D)评估]、手术资料以及1个月和1年随访资料。结果 在440例左主干病变和(或)三支血管病变患者中,糖尿病组患者176例(40.00%),其高血压病、外周动脉疾病和左回旋支病变比例较高而左心室射血分数较低(均P<0.05)。在1个月随访时,两组的主要不良心血管事件(MACE)和全因死亡率相似(均P>0.05),而在1年随访时,糖尿病组患者的全因死亡率明显高于非糖尿病组患者(P=0.013)。低左心室射血分数是成功血运重建1个月和1年内MACE和全因死亡的独立危险因素(均P<0.05)。最重要的是,无论是否患有糖尿病,在1个月和1年随访时,症状包括呼吸困难和心绞痛以及生活质量都有显著改善(均P<0.05)。糖尿病组患者显示出与非糖尿病组患者相似的呼吸困难和生活质量改善程度(均P>0.05),并且心绞痛缓解更为显著(P=0.013)。此外,每位患者的冠状动脉慢性完全闭塞病变数量是呼吸困难(OR 0.723,95%CI 0.525~0.997,P=0.048)和心绞痛缓解(OR 0.686,95%CI 0.473~0.995,P=0.047)的独立危险因素,而对比剂用量(OR 0.995,95%CI0.992~0.999,P=0.008)则是糖尿病患者生活质量改善的独立危险因素。结论 成功PCI对于缓解症状和提高生活质量有益,适用于患有糖尿病的左主干病变和(或)三支血管病变患者。Objective To investigate whether successful percutaneous coronary intervention(PCI)could improve symptoms and quality of life(QOL)in left main disease and/or 3-vessel disease patients with diabetes.Methods Patients with left main disease and/or 3-vessel disease who underwent PCI in the First Affiliated Hospital of Air Force Medical University from April 2018 to May 2021 were consecutively enrolled and subdivided into 2 groups:diabetes and no diabetes.Detailed baseline characteristics,symptoms,including dyspnea and angina,assessed with the Rose dyspnea scale(RDS),Seattle angina questionnaire(SAQ),the European quality of life-5 dimensions(EQ-5D)and 12-item short-form health survey(SF-12)questionnaire respectively,procedural details,and 1 month and 1 year follow-up data were collected.Results Among 440 left main disease and/or 3-vessel disease patients,disease was present in 176(40.00%),who had more hypertension,peripheral artery disease,and LCX lesion(all P<0.05).The incidence of major adverse cardiovascular events(MACE)and all-cause mortality were similar between the two groups(bothP>0.05)at 1 month follow-up,while all-cause mortality in diabetes patients was significantly higher than those without diabetes at 1 year follow-up(P=0.013).Low left ventricular ejection fraction was an independent risk factor for MACE and all-cause mortality at 1 month and 1 year follow-up after successful revascularization(all P<0.05).Most importantly,symptoms,including dyspnea and angina,and QOL were markedly improved regardless of diabetes both at 1 month and 1 year follow-up(all P<0.05).Diabetes patients showed improved dyspnea and QOL at similar degree to the non-diabetes patients(allP>0.05)and a more significantly relieved angina(P=0.013).Additionally,the number of chronic total occlusion(CTO)per patient was identified as an independent risk factor of dyspnea(OR 0.723,95%CI 0.525~0.997,P=0.048)and angina relief(OR 0.686,95%CI 0.473~0.995,P=0.047),and the contrast volume(OR0.995,95%CI0.992~0.999,P=0.008)as an independent risk fa

关 键 词：左主干病变 三支血管病变 糖尿病 症状 生活质量 

分 类 号：R541[医药卫生—心血管疾病]