摘要
目的 探讨术前糖化血红蛋白（HbA1c）水平对老年急性冠脉综合征（ACS）患者行经皮冠状动脉介入治疗（PCI）术后预后的影响以及围术期使用替罗非班的合理性.方法 连续选取2012年1月至2014年3月在解放军总医院行PCI术的ACS合并糖尿病（DM）的老年患者648例,按入院HbA1c水平分组：A组（HbA1c＜ 6.5％,152例）、B组（6.5％≤HbA1c≤7.5％,245例）和C组（HbA1c＞ 7.5％,251例）.按围术期是否使用替罗非班分组：X组（未使用,351例）,Y组（使用,297例）.比较各组术后1年主要及次要终点事件发生率,并用多因素Cox比例风险回归模型分析主要终点事件的相关危险因素.结果 （1）主要终点事件：A、B、C三组差异存在统计学意义（P＜0.01）;X组较Y组发生率高[68 （21.9％） vs33 （15.4％）,P＜0.05];X组中,不同HbA1c水平患者的主要终点事件发生率存在差异（P＜0.01）;而Y组中则差异无统计学意义（P＞0.05）.（2）次要终点事件：X、Y组仅在微量出血事件发生上差异具有统计学意义（P＜ 0.01）.（3）当HbA1c＞7.5％时,使用替罗非班能降低非致死性心肌梗死和支架内再狭窄发生率（P＜0.05）.（4）多因素Cox比例风险回归模型分析：心肌梗死病史、PCI/冠状动脉旁路移植术史、吸烟史、HbA1c水平和是否使用替罗非班是老年ACS合并DM患者1年内发生主要终点事件的独立预测因子.结论 术前HbA1c水平是ACS合并DM的老年患者PCI术后主要终点事件发生的重要预测因子,围术期加用替罗非班可减少术后主要终点事件发生,但有增加出血事件的风险.
Objective To determine the effect of preoperative serum level of glycosylated hemoglobin （HbAlc） on the prognosis of elderly patients with acute coronary syndromes （ACS） after percutaneous coronary intervention （PCI） and investigate the rationality of peri-operative use of tirofiban. Methods A prospective study was performed in our hospital from January 2012 to March 2014 on the consecutive elderly ACS patients with coexisting diabetes mellitus and planing to undergo PCI. For the admitted 648 patients, they were divided into 3 groups according to preoperative serum level of HbA 1 c, that is, group A （HbA 1 c 〈 6.5%, n = 152）, group B （6.5%-〈HhAle-7.5%, n = 245） and group C （HbAlc 〉 7.5%, n = 251）. The cohort was also assigned into group X （not use of tirofiban, n = 351） and group Y （using tirofiban, n = 297）. The incidences of primary and secondary endpoints were compared among these groups. Multivariate COX regression analysis was used to analyze the risk factors for the major endpoints. Results （1） Significant difference was found in the incidence of major endpoints among group A, B and C （P 〈 0.01）. The incidence was obviously higher in group X than in group Y [68（21.9%） vs 33（15.4%）, P 〈 0,05]. In group X, the incidence had remarkable difference among group A, B and C （P 〈 0.01）, but no such difference was observed in group Y. （2） Significant difference was only seen in the incidence of minimal bleeding events （secondary end points） between group X and Y （P 〈 0.01）. （3） Tirofihan reduced the incidence of nonfatal myocardial infarction （MI） and in-stent restenosis for those with HbAlc 〉 7.5% （group C）. （4） Multivariate COX regression analysis indicated that previous MI, previous PCI or coronary artery bypass surgery （CABG）, history of smoking, HbAlc level and application of tirofiban were the independent risk factors for major endpoints in elderly ACS patients withcoexisting diabetes mellitus within 1 year. Conclusion Preoperative HbAlc level is an important predictor for major endpoints in elderly diabetic patients with ACS after PCI. Combined peri-operative application of tirofiban reduces the incidence of the major endpoints, but increases the risk for bleeding events.
出处
《中华老年多器官疾病杂志》
2015年第5期329-334,共6页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
北京市科技计划项目（Z131100002613006）
