糖尿病患者冠状动脉药物洗脱支架内晚期丢失及非靶病变进展的影响因素

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。中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程全文链接：

Predictive factors for in-stent late loss and non-culprit coronary lesion progression in diabetic patients undergoing drug eluting stenting

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: Toexplore the predictive factors for in-stent late loss and non-culprit coronary lesion progression in patients with type 2 diabetes mellitus. METHODS:A total of 399 stenting patients were enrolled, including 179 diabetic patients and 220 non-diabetic patients. The clinical materials, angiography parameters and biochemical markers were collected. 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 smaller in the diabetic patients. The minimal lumen diameters of post-procedure and follow-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 follow-up after stenting (P=0.038, P=0.004). The follow-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.