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糖尿病对冠状动脉支架置入术后近期和远期效果的影响(摘要)
http://www.100md.com 《中国循环杂志》 1999年第0期
     作者:曲新凯 方唯一 刘日辉 刘欣

    单位:辽宁省大连市,大连医科大学附属第一医院 心内科(116011) 曲新凯 方唯一; 辽宁省,辽阳市第三人民医院 心内科 刘日辉;鞍钢铁西医院 心内科 刘 欣

    关键词:

    中国循环杂志99zk54 目的:糖尿病能促进经皮冠状动脉腔内成形术(percutaneous transluminal coronary angioplasty,PTCA)术后再狭窄的发生,但对支架置入术后(coronary stenting,CS)再狭窄的影响,意见尚不一致。本研究通过对比糖尿病和非糖尿病病人行CS后的近期及远期效果,分析糖尿病对CS后再狭窄的影响。

    方法:将108例大连医科大学附属第一医院1996~1999年能随访到的择期CS后病例,分成糖尿病组21例和非糖尿病组87例,以支架置入后残留狭窄小于10%为手术成功标准,对病变特征、住院及随访期心脏病事件发生和重复PTCA进行统计学分析。
, http://www.100md.com
    结果:2组的临床特征无显著性差异,但多支病变数(81.0%,57.5%,P<0.05)、多处病变数(81.0%,59.8%,P<0.05)、支架置入前狭窄程度[(98.0±6.0)%,(88.4±12.7)%,P<0.05)]有显著性差异;住院期间心绞痛发生率(9.5%,9.2%,P>0.05)、心肌梗塞(4.8%,2.3%,P>0.05)、心脏骤停(9.5%,2.3%,P>0.05)无显著性差异;随访6个月糖尿病组有心绞痛复发(47.6%,37.9%,P>0.05)、心肌梗塞(4.8%,0,P>0.05)、死亡(4.8%,1.1%,P>0.05)、重复PTCA(23.8%,10.3%,P>0.05)增加的趋势,但无统计学意义。

    结论:①高血糖导致弥漫性血管损害,使糖尿病合并冠心病病人表现为多支、多处、复杂病变特征,狭窄程度较高;②支架置入能获得最大限度的管径增加,并且消除弹性回缩和严重血管夹层所致的急性血管闭塞,故糖尿病合并冠心病病人能取得与非糖尿病病人相似支架置入术后近期效果;③支架置入消除血管重构,使内膜增殖成为再狭窄的决定性因素。尽管糖尿病能促进再狭窄的发生,但是,冠状动脉支架置入也能降低糖尿病人PTCA后的再狭窄发生率,其机制仍是由于冠状动脉腔进一步扩大所致。
, 百拇医药
    Influence of Diabetes Mellitus on Early and Late Outcome after Stent Placement (Abstract)

    Department of Cardiology, The First Hospital of Dalian Medical University, Dalian (116011), Liaoning

    Qu Xinkai, Fang Weiyi, Liu Rihui, et al.

    Objective: Diabetes mellitus (DM) can increase the risk of restenosis after percutaneous transluminal coronary angioplasty (PTCA), but there is not a consensus of opinion whether DM can increase the restenosis rate after coronary stenting (CS). The purpose of this study was to analyse the influence of DM on restenosis after CS by comparing the early and late outcome of patients with diabetes to non-diabetes.
, 百拇医药
    Methods: Data from 21 diabetic and 87 non-diabetic patients undergoing CS from The First Hospital of Dalian Medical University were statisticly analyzed.

    Results: The clinical characters were similar in diabetic and non-diabetic patients. However comparing with non-diabetic patients, the diabetic had more multi-vessels disease (81.0% versus 57.5%, p<0.05)、more multi-lesions (81.0% versus 59.8%, p<0.05) and greater degree of pre-CS stenosis [(98.0±6.0)% versus (88.4±12.7)%,p<0.05)]. For the rate of in-hospital angina recurrence (9.5% versus 9.2%, p<0.05)、 myocardial infarction (4.8% versus 2.3%, p>0.05) and cardiac arreat (9.5% versus 2.3%, p>0.05), the two groups had not significantly different. There was an increasing inclination of angina recurrence (47.6% versus 37.9%, p>0.05)、 myocardial infarction recurrence (4.8% versus 0, p>0.05)、 death (4.8% versus 1.1%, p>0.05) and re-PTCA (23.8% versus 10.3%, p>0.05) in diabetic group at six-month follow-up, but no significant difference.
, 百拇医药
    Conclusion: ①A multi-vessels and multi-lessions as the pathological characteristics of patient with DM was shown in our study; ②DM patients underwent coronary stenting can obtain a similar early outcome to non-diabetic cases, because stent implantation gains greater coronary lumen and eliminate the wall recoil and serious dissection indueed by acute cononary occlusion; ③Coronary remodeling as a factor of restenosis can be limited by stenting, although the intimal proliferation plays an important role in the restenosis, coronary stenting can reduce the rate of restenosis after PTCA in patients with DM through the mechanism of enlarging coronary lumen. Although the resenosis process could be promoted by increasing ECM and promoting thrombosis and smooth muscle cell proliferation, patients with DM could still gain similar late outcome to non-diabetic patients., 百拇医药