CAJ | 학술논문

背景：已有研究认为，冠心病合并2型糖尿病患者冠状动脉粥样硬化斑块进展和冠状动脉支架内再狭窄发生风险增加。目的：探讨2型糖尿病患者支架内再狭窄和非靶病变进展情况及其影响因素。方法：纳入399例冠心病接受冠状动脉支架置入患者，根据是否合并糖尿病将患者分为糖尿病组(n=179)和非糖尿病组(n=220)，收集一般资料、冠状动脉造影及支架置入相关参数；将糖尿病组根据是否发生支架内再狭窄分为再狭窄组(n=66)和无再狭窄组(n=113)，根据有无非靶病变快速进展分为非靶病变进展组(n=48)和非靶病变无进展组(n=131)，检测支架置入3，120，210，360 d的血低密度脂蛋白胆固醇、糖化血红蛋白、血浆纤维蛋白原和超敏C-反应蛋白水平。结果与结论：与非糖尿病组比较，糖尿病组冠状动脉支架长度更长(P=0.018)，支架直径更小(P=0.002)，支架置入后即刻和造影随访的最小管腔直径更小(P=0.001，P=0)，支架置入后即刻和造影随访的冠状动脉狭窄程度更严重(P=0.038，P=0.004)，造影随访晚期管腔丢失和再狭窄发生比例更多(P=0，P=0.097)。在糖尿病患者的亚组分析中，再狭窄者的血浆纤维蛋白原、超敏C-反应蛋白和糖化血红蛋白水平较无再狭窄者更高；非靶病变进展者的血浆纤维蛋白原、超敏C-反应蛋白和糖化血红蛋白水平较非靶病变未进展者更高。表明糖尿病患者发生支架内再狭窄和非靶病变进展的比例较高，同时血浆纤维蛋白原、超敏C-反应蛋白和糖化血红蛋白等生化指标可辅助预测再狭窄和非靶病变进展的发生。
배경：이유연구인위，관심병합병2형당뇨병환자관상동맥죽양경화반괴진전화관상동맥지가내재협착발생풍험증가。목적：탐토2형당뇨병환자지가내재협착화비파병변진전정황급기영향인소。방법：납입399례관심병접수관상동맥지가치입환자，근거시부합병당뇨병장환자분위당뇨병조(n=179)화비당뇨병조(n=220)，수집일반자료、관상동맥조영급지가치입상관삼수；장당뇨병조근거시부발생지가내재협착분위재협착조(n=66)화무재협착조(n=113)，근거유무비파병변쾌속진전분위비파병변진전조(n=48)화비파병변무진전조(n=131)，검측지가치입3，120，210，360 d적혈저밀도지단백담고순、당화혈홍단백、혈장섬유단백원화초민C-반응단백수평。결과여결론：여비당뇨병조비교，당뇨병조관상동맥지가장도경장(P=0.018)，지가직경경소(P=0.002)，지가치입후즉각화조영수방적최소관강직경경소(P=0.001，P=0)，지가치입후즉각화조영수방적관상동맥협착정도경엄중(P=0.038，P=0.004)，조영수방만기관강주실화재협착발생비례경다(P=0，P=0.097)。재당뇨병환자적아조분석중，재협착자적혈장섬유단백원、초민C-반응단백화당화혈홍단백수평교무재협착자경고；비파병변진전자적혈장섬유단백원、초민C-반응단백화당화혈홍단백수평교비파병변미진전자경고。표명당뇨병환자발생지가내재협착화비파병변진전적비례교고，동시혈장섬유단백원、초민C-반응단백화당화혈홍단백등생화지표가보조예측재협착화비파병변진전적발생。
BACKGROUND:Previous studies have suggested that the risks for coronary atherosclerotic plaque progression and in-stent restenosis are increased in patients with coronary heart disease combined with type 2 diabetes. OBJECTIVE:To explore the predictive factors for in-stent late loss and non-culprit coronary lesion progression in patients with type 2 diabetes mel itus. METHODS:A total of 399 stenting patients were enrol ed, including 179 diabetic patients and 220 non-diabetic patients. The clinical materials, angiography parameters and biochemical markers were col ected. The difference between the two groups was compared, and also we conducted subgroup analysis in the diabetic patients. Low-density lipoprotein cholesterol, hemoglobin A1c, fibrinogen and high-sensitivity C-reactive protein were detected at days 3, 120, 210 and 360 after stenting. RESULTS AND CONCLUSION:Compared with non-diabetic patients, the stent length (P=0.18) was longer and the stent diameter (P=0.002) was smal er in the diabetic patients. The minimal lumen diameters of post-procedure and fol ow-up angiography in the diabetic group were significantly decreased (P=0.001, P=0), and the diabetic patients also showed severe coronary artery stenosis instantly and within the fol ow-up after stenting (P=0.038, P=0.004). The fol ow-up angiography showed that the diabetic patients had more late loss and restenosis (P=0, P=0.097). Furthermore, in the subgroup analysis of diabetic patients, the levels of hemoglobin A1c, fibrinogen and high-sensitivity C-reactive protein were significantly increased in the patients with restenosis and non-culprit lesion progression. These findings indicate that diabetic patients appear to have the higher incidence of restenosis and non-culprit lesion progression. Moreover, hemoglobin A1c, fibrinogen and high-sensitivity C-reactive protein are effective predictors for in-stent late loss and non-culprit coronary lesion progression.