多支病变合并糖尿病完全血流重建对比研究

发布时间：2018-05-19 11:42

本文选题：糖尿病 + 多支病变　；参考：《浙江大学》2015年硕士论文

【摘要】：背景和目的糖尿病作为心血管疾病的独立危险因素,支架植入术后近远期支架内再狭窄率较不合并糖尿病者高,但大多的研究都未系统区分支架类型对试验结果影响。药物涂层支架可以通过抑制血管内膜及平滑肌增生,降低支架植入术后支架内再狭窄及靶血管再血流重建率。目前发表的多项研究表明合并糖尿病者的患者冠状动脉造影结果提示多支冠脉狭窄发生率增高。多支病变较单支病变支斑块更不稳定,心血管事件发生率高,同期或分期行完全血流重建治疗是安全可行的。目前国内关于多支病变合并糖尿病同期或分期单纯行药物支架完全血流重建预后的研究尚少,本研究旨在探讨糖尿病在血流动力学稳定的多支病变高危病例均行药物支架植入术后的预后影响。资料和方法连续收集临床2012年12月至2013年9月浙江大学医学院附属第二医院心血管内科住院的多支病变选择药物洗脱支架行完全血流重建病例共189例,合并糖尿病病例79例,不合并糖尿病患者110例,所有病例均处于血流动力学稳定,同期或90天内行PCI术且均为药物涂层支架植入,对狭窄冠脉主支及其主要分支行完全血流重建。分DM组和非DM组。统计两组病例一般资料：年龄、性别、吸烟史、高血压病史、脑梗死病史、糖化血红蛋白、血脂、术前LVEF,通过电话或门诊随访16-22月,记录两组病例术后随访期内MACE、支架内血栓形成及术后LVEF。结果按照纳入标准共189例病例纳入,DM组79例,非DM组110例,两组一般资料：年龄、性别、吸烟、高血压病史、脑梗死病史、血脂及术前LVEF无统计学差异(P0.05)。DM组平均糖化血红蛋白(HbA1c)高于非DM组,差别具有统计学意义(P=0.000)。病变血管支数DM组2.31+0.47支,非DM组2.40+0.49支,DM组3支病变35例(44.3%,n=79),非DM组42例(38.1%,n=110),无统计学差异(P=0.0.192,P=0.398)。DM组合并CT017例(21.5%),非DM组28例(25.4%),两组间无差异(P=0.531)。随访16-22月,其中DM组及非DM组均无死亡病例。DM组3例再发心肌梗死(3.7%),非DM组1例再发心肌梗死(0.9%),两组间统计学上无差异(P=0.174)。DM组中有1例随访期内支架内血栓形成(1.2%),非DM组随访期内无支架内血栓形成,P=0.418。DM组6例病例支架内再狭窄大于50%伴心肌缺血症状予行再次血流重建治疗(7.5%),非DM组随访期内1例支架内再狭窄明显行血流重建治疗(0.9%),两组间差异有统计学意义(P=0.044)。总MACE发生率方面,DM组共9例,非DM组共2例,差异具有统计学意义(P=0.014)。结论与不合并糖尿病患者相比,多支病变合并糖尿病同期或分期行PCI药物支架植入完全血流重建不增加全因死亡率、再发心肌梗死及支架内血栓形成,支架内再发狭窄、TVR及总MACE发生率高,符合目前研究结果。
[Abstract]:Background and purpose As an independent risk factor for cardiovascular disease, the rate of in-stent restenosis after stent implantation is higher than that of non-diabetic patients. However, most studies have not systematically distinguished the effect of stent type on the results of the trial. Drug-coated stents can inhibit intima and smooth muscle proliferation and reduce the rate of stent restenosis and target vessel reflow reconstruction after stent implantation. Recent studies have shown that coronary angiography in patients with diabetes suggests an increased incidence of multiple coronary artery stenosis. Multivessel lesions are more unstable than single vessel plaques, and the incidence of cardiovascular events is higher. It is safe and feasible to complete blood flow reconstruction at the same time or by stages. At present, there are few studies on the prognosis of multivessel disease complicated with diabetes mellitus by drug stents complete blood flow reconstruction at the same time or stage. The aim of this study was to investigate the prognostic effects of drug stent implantation in patients with diabetes mellitus (DM) who were at high risk of multivessel disease with stable hemodynamics. Information and methodology From December 2012 to September 2013, 189 patients with multivessel lesions in the Department of Cardiovascular Medicine affiliated to the second affiliated Hospital of Zhejiang University Medical College were selected for complete blood flow reconstruction by drug-eluting stents, and 79 cases were complicated with diabetes mellitus. All the patients were in stable hemodynamics. PCI was performed at the same time or 90 days with drug-coated stent implantation to reconstruct the main coronary artery and its main branches. The patients were divided into DM group and non DM group. Age, sex, smoking history, history of hypertension, history of cerebral infarction, glycosylated hemoglobin, blood lipids, preoperative LVEF, and follow-up by telephone or outpatient for 16-22 months were analyzed. Mace, stent thrombosis and postoperative LVEF were recorded in both groups. Result According to the inclusion criteria, 189 cases were included in DM group (79 cases) and non-DM group (110 cases). The general data of the two groups were age, sex, smoking, history of hypertension and history of cerebral infarction. There was no significant difference in serum lipids and preoperative LVEF. The average HbA1c in the DM group was higher than that in the non-DM group, and the difference was statistically significant. The number of vessel branches in DM group was 2.31 0.47, that in non-DM group was 2.40 0.49 branches, that in DM group was 44.3 and that in non-DM group was 38.1 and 0.398.DM and that in CT017 group was 21.55.There was no difference between the two groups. Follow up for 16-22 months, There were no death cases in DM group and non-DM group. There were 3 cases of recurrent myocardial infarction in DM group and 1 case in non-DM group. There was no statistical difference between the two groups. In the follow-up period, 1 case had thrombus formation in stent, and 1 case in non-DM group was followed up. Stent restenosis > 50% with myocardial ischemia symptoms in 6 patients without intrastenting thromboembolism. Reflow reconstruction therapy was performed in 6 cases. In non-DM group, one case with in-stent restenosis was obviously treated with blood flow reconstruction (0.9g / L) during the follow-up period. The difference was statistically significant (P = 0.044). The incidence of MACE in DM group (9 cases) and non-DM group (2 cases) was significantly higher than that in control group (P 0.014). Conclusion Compared with patients without diabetes mellitus, complete blood flow reconstruction with PCI stent implantation did not increase overall mortality, recurrent myocardial infarction and intrastent thrombosis in patients with multiple vessel disease and diabetes mellitus at the same time or in stages. The incidence of TVR and total MACE was high, which was consistent with the present study.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2

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