摘要
目的探讨稳定性冠心病合并2型糖尿病患者经皮冠状动脉介入术(PCI)治疗后糖化血红蛋白(HbA1c)控制水平对预后的影响。方法选择2017年1月至2019年1月在安康市中心医院心内科接受治疗的冠心病合并2型糖尿病患者130例作为研究对象,所有患者经PCI术后行血糖控制并随访6个月,随访6个月后根据两组患者的HbA1c水平分为对照组和观察组。观察组60例,HbA1c水平均低于7.0%,对照组70例,HbA1c水平均在7.0%以上。术后6个月检测并比较两组患者的血糖相关实验室指标水平变化[包括血清总胆固醇(TC)、甘油三脂(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBG)、餐后2 h血糖(2 hPBG)];比较两组患者随访6个月内的不良心血管事件(MACE)发生情况,并采用多因素Logistic回归分析血糖控制水平与MACE的相关性。结果PCI术后随访6个月,观察组患者的HbA1c水平为(6.41±0.23)%,明显低于对照组的(8.95±1.20)%,差异有统计学意义(P<0.05);观察组和对照组患者的TC[(5.25±0.05)mmol/L vs(6.26±1.15)mmol/L]、TG[(2.40±0.18)mmol/L vs(3.43±1.17)mmol/L]、LDL-C[(3.33±0.01)mmol/L vs(4.37±0.51)mmol/L]、FBG[(7.09±1.21)mmol/L vs(9.52±2.29)mmol/L]、餐后2 hPBG[(8.03±1.19)mmol/L vs(10.02±2.25)mmol/L]比较,观察组明显低于对照组,而观察组患者的HDL-C为(1.51±0.14)mmol/L,明显高于对照组的(0.75±0.16)mmol/L,差异均有统计学意义(P<0.05);随访期间观察组患者的MACE发生率为5.0%,明显低于对照组的20.0%,差异具有统计学意义(P<0.05);经多因素Logistic回归分析结果显示,只有血糖控制水平是否良好是MACE事件发生的危险因素(P<0.05)。结论稳定性冠心病合并2型糖尿病患者PCI术后有效控制HbA1c水平有助于减少不良血管事件的发生,改善临床预后。
Objective To investigate the effect of glycosylated hemoglobin(HbA1 c)control on prognosis in patients with stable coronary heart disease complicated with type 2 diabetes after percutaneous coronary intervention(PCI).Methods A total of 130 patients with coronary heart disease and type 2 diabetes who were treated in the Department of Cardiology,Ankang Central Hospital from January 2017 to January 2019 were enrolled.All patients underwent blood glucose control after PCI and were followed up for 6 months.After 6 months of follow-up,the Hb A1 c levels of the two groups were divided into control group and observation group.Patients in the observation group(n=60)had Hb A1 c level lower than 7.0%,while patients in the control group(n=70)had Hb A1 c level above 7.0%.Six-month postoperative follow-up was performed to detect and compare changes in blood glucose related laboratory indicators,including serum total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),fasting blood glucose(FBG),and 2 h postprandial blood glucose(2 h PBG)in the two groups.The incidence of adverse cardiovascular events(MACE)within 6 months was compared between the two groups,and the correlation between blood glucose control level and MACE was analyzed by multivariate Logistic regression.Results After PCI,the Hb A1 c level in the observation group was(6.41±0.23)%,significantly lower than(8.95±1.20)%in the control group(P<0.05).TC,TG,LDL-C,FBG,2 h PBG in the observation group were significantly lower than those in the control group(P<0.05):(5.25±0.05)mmol/L vs(6.26±1.15)mmol/L,(2.40±0.18)mmol/L vs(3.43±1.17)mmol/L,(3.33±0.01)mmol/L vs(4.37±0.51)mmol/L,(7.09±1.21)mmol/L vs(9.52±2.29)mmol/L,and(8.03±1.19)mmol/L vs(10.02±2.25)mmol/L.HDL-C in the observation group was(1.51±0.14)mmol/L,which was significantly higher than(0.75±0.16)mmol/L in the control group(P<0.05).During the follow-up,the incidence of MACE in the observation group was 5.0%,which was significantly lower than 20.0%in the control group,and the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that blood glucose control level was the risk factor for MACE events(P<0.05).Conclusion The effective control of HbA1 c after PCI in patients with stable coronary heart disease combined with type2 diabetes can reduce the incidence of adverse vascular events and improve the clinical prognosis.
作者
刘莎
陈庭燕
李毅
孙朝阳
周坤
刘发俊
LIU Sha;CHEN Ting-yan;LI Yi;SUN Chao-yang;ZHOU Kun;LIU Fa-jun(Department of Cardiology,Ankang Central Hospital,Ankang 725000,Shaanxi,CHINA)
出处
《海南医学》
CAS
2020年第5期559-562,共4页
Hainan Medical Journal
关键词
经皮冠状动脉介入
冠心病
糖尿病
糖化血红蛋白
预后
Percutaneous coronary intervention
Coronary heart disease(CHD)
Diabetes
HbA1c
Prognosis
