CAJ | 학술논문

目的：目前有不少随机对照临床试验比较西罗莫司洗脱支架（SES）与紫杉醇洗脱支架（PES）的介入治疗对于合并糖尿病的冠心病患者的临床及影像结果，但是还缺乏循证医学的证据来进一步证实到底哪一种支架更适合这类人群。方法在循证医学思想的指导下，系统性搜索已发表的相关临床研究，并对纳入的研究进行质量评价，对相关结果进行meta分析，更好地评估两种支架在合并糖尿病的冠心病患者中的作用。结果共纳入5篇随机对照临床试验，这些研究共纳入1264例糖尿病合并冠状动脉病变的患者，其中有644例患者分配到S ES组，另外620例患者分配到PES组。meta分析结果证明，SES的介入治疗在以下几个方面优于PES的介入治疗，血管再狭窄率（OR：0．31，95％ CI：0．18～0．53，P＜0．01）、后期管腔丧失（WMD ：－0．32，95％ CI：－0．39～－0．25，P＜0．01）、靶病变血运重建（OR：0．41，95％ CI：0．25～0．66，P＝0．0002）以及主要心血管事件发生率（OR：0．42，95％C I：0．25～0．69，P＝0．0008）。但是其他方面包括最后的最小管腔直径、总的病死率、心脏原因的病死率、心肌梗死率以及支架血栓发生率，两种支架的介入治疗并没有明显差异。结论总的来说，SES优于PES ，至少在预防血管再狭窄、靶病变血运重建和主要心血管事件方面优于PES。
목적：목전유불소수궤대조림상시험비교서라막사세탈지가（SES）여자삼순세탈지가（PES）적개입치료대우합병당뇨병적관심병환자적림상급영상결과，단시환결핍순증의학적증거래진일보증실도저나일충지가경괄합저류인군。방법재순증의학사상적지도하，계통성수색이발표적상관림상연구，병대납입적연구진행질량평개，대상관결과진행meta분석，경호지평고량충지가재합병당뇨병적관심병환자중적작용。결과공납입5편수궤대조림상시험，저사연구공납입1264례당뇨병합병관상동맥병변적환자，기중유644례환자분배도S ES조，령외620례환자분배도PES조。meta분석결과증명，SES적개입치료재이하궤개방면우우PES적개입치료，혈관재협착솔（OR：0．31，95％ CI：0．18～0．53，P＜0．01）、후기관강상실（WMD ：－0．32，95％ CI：－0．39～－0．25，P＜0．01）、파병변혈운중건（OR：0．41，95％ CI：0．25～0．66，P＝0．0002）이급주요심혈관사건발생솔（OR：0．42，95％C I：0．25～0．69，P＝0．0008）。단시기타방면포괄최후적최소관강직경、총적병사솔、심장원인적병사솔、심기경사솔이급지가혈전발생솔，량충지가적개입치료병몰유명현차이。결론총적래설，SES우우PES ，지소재예방혈관재협착、파병변혈운중건화주요심혈관사건방면우우PES。
Objective To investigate the evidence‐based medicine evidences for further verifying whether the sirolimus‐eluting stent(SES) or the paclitaxel‐eluting stent (PES) is more suitable for the patients with coronary heart disease(CHD) complicating diabetes although some randomized controlled trials (RCT ) were conducted for comparing the clinical and image results of the interventional therapy of ESE and PES .Methods The related pub‐lished researches was systematically retrieved by searching electronic databases under the guidance of the evidence‐based medicine thinking .All included researches were performed the quality evaluation and the related results were conducted the meta analysis for better assessing the role of SES and PES in treating diabetes complicating CHD .Re‐sults 5 RCT were included ,involving 1 264 patients with diabetes complicating CHD (644 cases in the SES group and 620 cases in the PES group) .The meta analysis results indicated that SES was superior to PES in the aspects of angiographic binary restenosis(OR:0 .31 ,95% CI:0 .18-0 .53 ,P<0 .01) ,late luminal loss(WMD :-0 .32 ,95% CI:-0 .39- -0 .25 ,P<0 .01) ,target lesion revascularization (OR:0 .41 ,95% CI:0 .25-0 .66 ,P=0 .000 2) and the oc‐currence rate of major adverse cardiac events (OR:0 .42 ,95% CI:0 .25-0 .69 ,P=0 .000 8) .But the other aspects in‐cluding final minimal lumen diameter ,total death rate ,death rate due to cardiac causes ,myocardial infarction rate and the occurrence rate of stent thrombosis had no sitnificant differences between SES and PES .Conclusion SES is supe‐rior to PES at least in the aspects of preventing angiographic binary restenosis ,target lesion revascularization and ma‐jor adverse cardiac events in patients with diabetes complicating CHD .