中国急性心肌梗死患者合并糖尿病的现状、治疗及预后

发布时间：2018-05-30 13:09

本文选题：急性心肌梗死 + 糖尿病　；参考：《北京协和医学院》2017年硕士论文

【摘要】：目的:近年来急性心肌梗死发病率逐年上升,而糖尿病也同样快速增加,本研究通过国家级注册登记研究数据分析急性心肌梗死合并糖尿病的现状、发病特点、治疗及预后。方法:中国急性心肌梗死注册登记(the China acute myocardial infarction registry)是基于中国各省三层级医院的针对急性心肌梗死患者发病、诊治、预后的临床信息所进行的一项非干预性、多中心、前瞻性、国家级注册登记研究,包括全国31个省直辖市省地县三级108医院参加。入选在各医院就诊的所有发病后7天内的急性心肌梗死患者(包括急性ST段抬高型心肌梗死和急性非ST段抬高型心肌梗死),并进行2年随访。本研究分析了 2013年1月至2014年9月登记的急性心肌梗死患者合并糖尿病的特点、治疗、住院期预后。结果:从2013年1月1日至2014年9月30日一共注册了 26624例急性心肌梗死患者,25197例记录了有无糖尿病病史,其中20%有糖尿病病史,中国北方比南方合并糖尿病比例高(21.8%vs.17.2%,P0.001),省级医院和地级医院合并糖尿病比例高于县级医院(省级医院21.9%,地级医院19.9%,县级医院16.3%,P0.001)。急性心肌梗死合并糖尿病患者年龄较大,女性较多,更多合并肥胖、高血压、高脂血症等多种危险因素,既往心肌梗死、心衰、脑卒中、外周血管疾病、肾功能不全多种疾病。住院期间阿司匹林、ADP受体抑制剂、他汀药比例均高于90%,急性ST段抬高性心肌梗死合并糖尿病患者急诊再灌注治疗率与无糖尿病患者相似(56%vs.58%,P0.05),非急性ST段抬高性心肌梗死合并糖尿病患者冠状动脉搭桥比例高于无糖尿病患者(5.4%vs.2.7%,P=0.01)。急性心肌梗死合并糖尿病患者的院内死亡率明显高于不合并糖尿病患者(Adjusted OR=1.32,95%CI:1.05-1.68,P0.05)。结论:中国急性心肌梗死患者合并糖尿病比例较高并有地区差异,急性心肌梗死合并糖尿病患者的危险因素更多,院内死亡率明显高于不合并糖尿病患者,应进一步积极急诊再灌注、血运重建及并发症的治疗。
[Abstract]:Objective: in recent years, the incidence of acute myocardial infarction (AMI) has been increasing year by year, and diabetes mellitus has also increased rapidly. This study analyzed the status, characteristics, treatment and prognosis of acute myocardial infarction complicated with diabetes mellitus by national registration data. Methods: the registration of acute myocardial infarction (AMI) in China was based on clinical information on the onset, diagnosis and prognosis of patients with acute myocardial infarction (AMI) in three levels of hospitals in all provinces of China. State-level registration research, including 31 provinces directly under the Central Government, provincial and county level 108 hospitals to participate. All patients with acute myocardial infarction (including acute St segment elevation myocardial infarction and acute non-St segment elevation myocardial infarction) within 7 days after onset were enrolled and followed up for 2 years. This study analyzed the characteristics, treatment, and prognosis of diabetes mellitus in patients with acute myocardial infarction (AMI) registered from January 2013 to September 2014. Results: from January 1, 2013 to September 30, 2014, a total of 26624 patients with acute myocardial infarction (AMI) had a history of diabetes, 20% of them had a history of diabetes. The proportion of diabetes in northern China is higher than that in south China (21.8vs.17.2), and the proportion of diabetes in provincial hospitals and prefectural hospitals is higher than that in county-level hospitals (21.9cm in provincial hospitals, 19.9in prefecture-level hospitals, 16.3cum in county-level hospitals) (P 0.001). Patients with acute myocardial infarction complicated with diabetes mellitus were older, more women, more complicated with obesity, hypertension, hyperlipidemia and other risk factors, past myocardial infarction, heart failure, stroke, peripheral vascular disease, renal insufficiency many kinds of diseases. Aspirin ADP receptor inhibitor during hospitalization, The proportion of statins was higher than 90. The rate of emergency reperfusion treatment in patients with acute ST-segment elevation myocardial infarction with diabetes was similar to that of non-diabetic patients. The coronary artery bypass grafting was similar to that of non-ST-elevation myocardial infarction with diabetes mellitus. The ratio was higher than that of non-diabetic patients (5.4% vs 2.7%). The nosocomial mortality in patients with acute myocardial infarction and diabetes was significantly higher than that in patients without diabetes mellitus (Adjusted OR1.3295 CI: 1.05-1.68) (P 0.05). Conclusion: the proportion of acute myocardial infarction patients with diabetes mellitus is higher in China and there are regional differences. The risk factors of acute myocardial infarction patients with diabetes mellitus are more, and the in-hospital mortality is significantly higher than that of non-diabetic patients. It is necessary to further active emergency reperfusion, revascularization and treatment of complications.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22;R587.1

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