反应性充血指数对急性冠脉综合征合并糖尿病患者预后预测价值研究
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摘要
目的探讨反应性充血指数(RHI)对急性冠脉综合征(ACS)合并糖尿病患者行冠脉支架置入术(PCI)后1年主要心血管事件(MACE)的预测价值。方法选取自2015年12月至2016年12月陆军军医大学新桥医院心内科收治的113例ACS合并糖尿病PCI术后患者为研究对象。根据RHI将患者分为正常内皮功能(NEF)组与内皮功能障碍(DEF)组。所有患者均接受12个月的随访调查。结果 DEF组患者MACE事件发生率显著高于NEF组,两组间比较,差异有统计学意义(P<0.05)。多变量Cox危险分析提示RHI为ACS合并糖尿病患者PCI术后1年MACE事件的独立预测因子(95%可信区间1.07～9.69,P<0.05)。Kaplan-Meier分析显示,DEF组累积MACE发生率高于NEF组,两组间比较,差异有统计学意义(P<0.05)。结论 RHI<1.67是ACS合并糖尿病患者PCI术后1年临床预后的独立预测因子。
Objective To investigate the predictive value of reactive hyperemia index(RHI-PAT index) for major cardiovascular events(MACEs) in patients with acute coronary syndrome(ACS) and diabetes mellitus one year after coronary stenting(PCI).Methods A retrospective study was performed on 113 cases of patients with ACS complicated with diabetes after PCI who were admitted from December 2015 to December 2016.Patients were divided into the normal endothelial function(NEF) group and the endothelial dysfunction(DEF) group according to RHI.All patients were followed up for 12 months.Results The incidence of MACEs events in DEF group was significantly higher than that in NEF group,and the difference between the two groups was statistically significant(P<0.05).Multivariate Cox hazard analysis suggested that RHI was an independent predictor of MACES events 1 year after PCI in ACS patients with diabetes mellitus(95% confidence interval 1.07-9.69,P<0.05).Kaplan-Meier analysis showed that the cumulative MACEs incidence in DEF group was higher than that in NEF group(P<0.05).Conclusion RHI<1.67 was an independent predictor of clinical prognosis of ACS patients with diabetes after PCI 1 year after surgery.
Objective To investigate the predictive value of reactive hyperemia index(RHI-PAT index) for major cardiovascular events(MACEs) in patients with acute coronary syndrome(ACS) and diabetes mellitus one year after coronary stenting(PCI).Methods A retrospective study was performed on 113 cases of patients with ACS complicated with diabetes after PCI who were admitted from December 2015 to December 2016.Patients were divided into the normal endothelial function(NEF) group and the endothelial dysfunction(DEF) group according to RHI.All patients were followed up for 12 months.Results The incidence of MACEs events in DEF group was significantly higher than that in NEF group,and the difference between the two groups was statistically significant(P<0.05).Multivariate Cox hazard analysis suggested that RHI was an independent predictor of MACES events 1 year after PCI in ACS patients with diabetes mellitus(95% confidence interval 1.07-9.69,P<0.05).Kaplan-Meier analysis showed that the cumulative MACEs incidence in DEF group was higher than that in NEF group(P<0.05).Conclusion RHI<1.67 was an independent predictor of clinical prognosis of ACS patients with diabetes after PCI 1 year after surgery.
引文
[1] Deedwania P,Acharya T,Kotak K,et al.Compliance with guideline-directed therapy in diabetic patients admitted with acute coronary syndrome:findings from the American Heart Association′s Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) program[J].Am Heart J,2017,187:78-87.
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[3] Booth GL,Kapral MK,Fung K,et al.Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people:a population-based retrospective cohort study[J].Lancet,2006,368(9529):29-36.
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[8] Pries AR,Badimon L,Bugiardini R,et al.Coronary vascular regulation,remodelling,and collateralization:mechanisms and clinical implications on behalf of the working group on coronary pathophysiology and microcirculation[J].Eur Heart J,2015,36(45):3134-3146.
[9] Davidson MB.Counterpoint:postprandial glucose levels are not a clinically important treatment target[J].Diabetes Care,2010,33(8):1908-1910.
[10] Borlaug BA,Olson TP,Lam CS,et al.Global cardiovascular reserve dysfunction in heart failure with preserved ejection fraction[J].J Am Coll Cardiol,2010,56(11):845-854.
[2] 邬美翠,陆林,吴立群,等.冠心病合并2型糖尿病冠状动脉造影特点分析[J].上海交通大学学报,2008,28(9):1196-1197.
[3] Booth GL,Kapral MK,Fung K,et al.Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people:a population-based retrospective cohort study[J].Lancet,2006,368(9529):29-36.
[4] Gimbrone MA Jr,Garcia-Cardena G.Endothelial cell dysfunction and the pathobiology of atherosclerosis[J].Circ Res,2016,118(4):620-636.
[5] Tuttolomondo A,Casuccio A,Della Corte V,et al.Endothelial function and arterial stiffness indexes in subjects with acute ischemic stroke:relationship with TOAST subtype[J].Atherosclerosis,2017,256(16):94-99.
[6] Rubinshtein R,Kuvin JT,Soffler M,et al.Assessment of endothelial function by non-invasive peripheral arterial tonometry predicts late cardiovascular adverse events[J].Eur Heart J,2010,31(9):1142-1148.
[7] Wallentin L,Becker RC,Budaj A,et al.Ticagrelor versus clopidogrel in patients with acute coronary syndromes[J].N Engl J Med,2009,361(11):1045-1057.
[8] Pries AR,Badimon L,Bugiardini R,et al.Coronary vascular regulation,remodelling,and collateralization:mechanisms and clinical implications on behalf of the working group on coronary pathophysiology and microcirculation[J].Eur Heart J,2015,36(45):3134-3146.
[9] Davidson MB.Counterpoint:postprandial glucose levels are not a clinically important treatment target[J].Diabetes Care,2010,33(8):1908-1910.
[10] Borlaug BA,Olson TP,Lam CS,et al.Global cardiovascular reserve dysfunction in heart failure with preserved ejection fraction[J].J Am Coll Cardiol,2010,56(11):845-854.