周军,林松,郑亚国

• 1:南京市第一医院南京医科大学附属南京医院心内科
• 2:南京市栖霞区医院心内科

摘要(Abstract)：

目的 探讨糖尿病对冠状动脉左主干病变患者行经皮冠状动脉介入治疗（PCI）术后远期预后的影响。方法 回顾性分析2011年7月至2022年8月在南京市第一医院确诊为冠状动脉左主干病变并行PCI的2 778例患者的临床资料。根据是否合并糖尿病，将患者分为糖尿病组（931例）和非糖尿病组（1 847例）。对所有患者进行术后随访，中位随访时间40个月。主要观察终点为全因死亡，次要终点包括心源性死亡、再发心肌梗死、支架内血栓形成、缺血性脑卒中、靶血管血运重建，主要安全终点为出血学术研究联合会（BARC）定义的3型或5型大出血。此外，根据患者基线是否接受胰岛素治疗进行亚组分析，比较两组间全因死亡等临床预后的差异。结果 两组患者基线资料比较，糖尿病组高血压（77.4%比68.3%,P<0.001）、高脂血症（76.7%比72.8%,P=0.026）、既往心肌梗死史（12.4%比9.6%,P=0.028）及既往PCI史（22.2%比18.0%,P=0.007）的比例显著升高；且更易合并严重或复杂的冠状动脉病变，表现为更高比例的三支血管病变（57.9%比48.8%,P<0.001）与真性分叉病变（51.8%比45.5%,P=0.002）。中位随访40个月，糖尿病组全因死亡率（16.0%比10.9%,P<0.001）显著高于非糖尿病组。进一步分析显示，糖尿病组心源性死亡（9.5%比5.1%,P<0.001）、再发心肌梗死（4.7%比2.6%,P=0.002）、靶血管血运重建（13.6%比9.1%,P<0.001）及支架内血栓形成（7.4%比3.7%,P<0.001）发生率均显著高于非糖尿病组，差异均有统计学意义；但两组间的缺血性脑卒中和大出血发生率比较，差异均无统计学意义（均P>0.05）。多因素Cox回归分析表明，合并糖尿病是左主干病变患者PCI术后发生全因死亡的独立危险因素（HR1.44,95%CI 1.16～1.78,P=0.001）。糖尿病亚组分析显示胰岛素治疗组较非胰岛素治疗组全因死亡率显著升高（20.1%比13.6%,P=0.001）。结论 糖尿病显著增加了左主干病变患者PCI术后的远期心血管事件风险，且在接受胰岛素治疗的亚组中尤为显著。

关键词(KeyWords)： 糖尿病;左主干病变;经皮冠状动脉介入治疗;预后

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金青年基金项目（81900248）

作者(Author): 周军,林松,郑亚国

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