【作者】 裴晓冬；

【导师】 贾大林；

【作者基本信息】 中国医科大学 ， 内科学， 2010， 硕士

【摘要】 目的以非糖尿病冠心病患者做对照组,观察冠心病合并糖尿病冠脉弥漫长病变患者经药物支架治疗一年后的预后。方法共入选238例经雷帕霉素药物涂层支架治疗的患者,糖尿病组77例(男性44例,女性33例,平均年龄61.79±10.62岁)；非糖尿病组161例(男性112例,女性49例,平均年龄60.37±11.21岁),均为冠脉弥漫长病变(病变长度大于20mm以上)。入选患者排除①合并其他心脏病,如扩张型心肌病、肥厚梗阻型心肌病、风湿性心脏病和甲亢型心脏病等；②既往有PCI (percutaneous coronary intervention)史;③肝、肾功能异常；④急性心梗一个月以内的患者(非ST段抬高型心梗除外)；⑤合并出血性疾病,不能耐受长期服用抗血小板药物；⑥合并严重感染、恶性肿瘤、血液系统和免疫系统等疾病。详细记录所有入选患者的姓名,性别,年龄,联系电话,入院时血压,血脂(LDL-C),是否吸烟,心脏彩超的E值,A值及左室射血分数(Left ventricular ejection fraction LVEF),冠脉病变部位、长度、平均支架数、支架管径、支架长度。通过电话、门诊随访记录一年后患者心脏不良事件(major adverse cardiac event MACE)的发生率,包括再发心绞痛,心肌梗死,冠脉搭桥及心源性死亡。门诊复查心脏超声记录二尖瓣血流频谱舒张早期速度E和舒张晚期速度A,以及左心室射血分数(LVEF),二尖瓣环室间隔和侧壁舒张早期峰速度Esep和Elat,两者的均值Ea。分别以二尖瓣血流频谱舒张早期和舒张晚期血流峰值之比E/A、Esep、Elat、Ea、E/Esep、E/Elat和E／Ea作为评价左心室舒张功能指标。所有数据采用SPSS16.0软件包处理,以P<0.05表示有统计学意义。糖尿病组与非糖尿病组间的临床基本资料除LDL-C糖尿病组高于非糖尿病组外,其余均无无统计学差异。除糖尿病组一年后再发心绞痛发生率高于非糖尿病组外(P=0.029),有统计学差异,其他一年后再发心梗(P=0.732),冠脉搭桥手术(coronary artery bypass grafting CABG)(P=0.400),心源性死亡的发生率(P=0.448),左心室的功能(P=0.236)两组间均无统计学差异。两组患者治疗一年后EF值较一年前有明显的提高,糖尿病组治疗前后分别为52.74±11.70 vs 66.67±2.38；非糖尿病组分别为55.13±9.52 vs 66.12±3.33；E／A比值也由一年前的小于1改善到大于1,糖尿病组治疗前为0.70±0.19／0.85±0.21,治疗后为0.85±0.14／0.72±0.09；非糖尿病组治疗前为0.68±0.19／0.83±0.18,治疗后为0.85±0.18／0.73±0.09。结论糖尿病与非糖尿病冠心病患者冠脉弥漫长病变经介入治疗一年后,心肌梗死,CABG,心源性死亡发生率和左心室功能相当；而糖尿病组再发心绞痛的发生率高于非糖尿病组。糖尿病与非糖尿病冠心病患者冠脉弥漫长病变经雷帕霉素药物涂层支架治疗可以明显改善预后。更多还原

【Abstract】 ObjectiveTo observe the prognosis of diabetes and non-diabetic patients with coronary heart disease diffuse long lesions after sirolimus—eluting stents one year.MethodsA total of 238 cases with coronary heart disease diffuse long lesions after sirolimus—eluting stents, including diabetic group of 77cases (male 44, female 33 cases, with an average age of 61.79±10.62 years):non-diabetic group of 161 cases (male 112 cases, and 49 females with a mean age of 60.37±11.21 years), are filled with long coronary lesions (lesion length greater than 20mm and above). Patients were excluded for the following reasons:①patients selected to exclude the merger of other heart disease, such as dilated cardiomyopathy, hypertrophic obstructive cardiomyopathy, rheumatic heart disease and hyperthyroidism heart disease;②history of PCI;③liver and kidney dysfunction;④acute myocardial infarction within one month (except for non-ST-segment elevation myocardial infarction);⑤hemorrhagic disease can not tolerate long-term use of anti-platelet drugs;⑥associated with severe infections, malignancies, blood and immune systems and other diseases. Detailed record of all the selected patient’s name, sex, age, telephone number, admission blood pressure, blood lipids (LDL-C), smoking, the heart of the E value of color Doppler ultrasound, A values and left ventricular ejection fraction (LVEF), coronary artery lesion length, the number of stents. stent diameter, stent length. By phone, out-patient follow-up records of major adverse cardiac events(MACE) in patients after one year, including recurrent angina, myocardial infarction, coronary artery bypass grafting(CABG) and cardiac death. Review out-patient cardiac color Doppler ultrasound recording of early diastolic mitral flow velocity E and late diastolic velocity A. and left ventricular ejection fraction (LVEF). interventricular septum and lateral mitral annular early diastolic peak velocity Esep and Elat. both The mean Ea. Respectively diastolic mitral flow peak early and late diastolic blood flow ratio of E/A. Esep, Elat. Ea, E/Esep. E/Elat and the E/Ea for evaluating left ventricular diastolic function parameters. All data used SPSS 16.0 package deal, to P<0.05 indicated statistical significance.ResultsThe basic information of clinical from diabetic group and non-diabetic groups has not statistical difference, except LDL-C diabetes group was higher than non-diabetic group. In addition to the incidence of angina diabetic group is higher than non-diabetic group (P= 0.029), the others have not statistical difference between the two groups, myocardial infarction (P= 0.732). coronary artery bypass graft surgery (CABG) (P= 0.400), the incidence of cardiac death (P= 0.448). left ventricular function (P= 0.236). After one year of therapy, the LVEF values is higher than a year ago,it has significantly improved, and diabetes before and after treatment were 52.74±11.70 vs 66.67±2.38; non-diabetic group were 55.13±9.52 vs 66.12±3.33; E/A ratio is also by less than 1 a year ago, improved to greater than 1, diabetic group before treatment 0.70±0.19/0.85±0.21, after treatment 0.85±0.14/0.72±0.09; non-diabetic group before treatment 0.68±0.19/0.83±0.18, after treatment 0.85±0.18/0.73±0.09.ConclusionDiabetes and non-diabetic patients with coronary diffuse long lesions after sirolimus—eluting stents one year, myocardial infarction, CABG, the incidence of cardiac death and left ventricular function are no difference, the incidence of angina diabetic group is higher than non-diabetic group. Diabetes and non-diabetic patients with coronary heart disease diffuse long coronary lesions after sirolimus—eluting stents can significantly improve the prognosis of one year.更多还原