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目的:评价糖尿病对雷帕霉素药物洗脱支架临床疗效的影响。方法:选择2002年12月至2005年5月应用雷帕霉素药物洗脱支架(Cypher)的冠心病合并糖尿病患者262例(糖尿病组)和非糖尿病患者262例(对照组),平均随访8个月,患者均复查冠状动脉造影,分析不良心脏事件(心性死亡,急性心肌梗死或靶病变重建)和冠状动脉造影复查结果,评价糖尿病对Cypher支架临床近远期疗效的影响。结果:1.2组支架植入成功率均为100%,糖尿病组无死亡,6例于术后第2天发生急性心肌梗死,对照组无死亡,11例于随访6个月时发生急性心肌梗死;2.复查冠状动脉造影显示糖尿病组和对照组晚期管腔绝对内径丢失分别为(0.06±0.02)mmvs(0.04±0.02)mm(P>0.05),相对内径丢失分别为(2.32±0.19)%vs(1.63±0.14)%(P=0.03)。因再狭窄行靶血管重建者分别为33例(12.60%)和26例(9.92%)(P>0.05)。回归分析显示,相关血管大小和相对管腔内径丢失与再狭窄有关。结论:糖尿病患者应用Cypher支架安全有效,但相对内径丢失明显,糖尿病合并小血管可能是雷帕霉素药物洗脱支架再狭窄的影响因素。
Objective: To evaluate the effect of diabetes on the clinical efficacy of rapamycin eluting stent. Methods: Two hundred and sixty-two patients with diabetes mellitus (DM group) and 262 non-diabetic patients (control group) with coronary heart disease complicated with diabetes treated with rapamycin-eluting stent (Cypher) from December 2002 to May 2005 were selected. The patients were followed up for an average of 8 Months, the patients were reviewed coronary angiography, analysis of adverse cardiac events (cardiac death, acute myocardial infarction or target lesion reconstruction) and coronary angiography review results to assess the clinical short-term effect of Cypher stent on the effect. Results: The successful rate of stent implantation was 100% in 1.2 groups, no death in diabetic group, 6 cases of acute myocardial infarction on the 2nd day after operation, no death in the control group and 11 cases of acute myocardial infarction at 6 months of follow - up. 2. Review of coronary angiography showed that the absolute loss of endovascular diameter was (0.06 ± 0.02) mm vs (0.04 ± 0.02) mm respectively in diabetic group and control group (2.32 ± 0.19)% vs (1.63 ± 0.14)% (P = 0.03). 33 cases (12.60%) and 26 cases (9.92%) of restenosis target vessel remodeling respectively (P> 0.05). Regression analysis showed that related vessel size and relative luminal diameter loss were associated with restenosis. Conclusion: The Cypher stent is safe and effective in patients with diabetes mellitus, but the relative internal diameter loss is obvious. Diabetic patients with small blood vessels may be the influencing factors of restenosis in rapamycin-eluting stent.