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脉压对2型糖尿病合并急性ST段抬高型心肌梗死患者预后的影响

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目的 探讨脉压(PP)对2型糖尿病(T2DM)合并急性ST段抬高型心肌梗死(STEMI)患
者预后的影响。方法 选择2015年7月至2018年6月于解放军总医院第七医学中心干四科住院的STEMI患
者125例,分为T2DM合并STEMI组(56例)和单纯STEMI组(69例)。对两组患者进行全球急性冠状动
脉事件的注册研究(Global Registry of Acute Coronary Events,GRACE)危险评分,并分析危险因素与患
者预后的相关性。结果 T2DM合并STEMI组患者的GRACE危险评分、冠状动脉(冠脉)狭窄程度积分
(Gensini积分)、PP、平均收缩压(SBP)、空腹血糖(FPG)、糖化血红蛋白(HbAlc)、低密度脂蛋
白胆固醇(LDL-C)、载脂蛋白B(ApoB)均高于单纯STEMI组(P均<0.05);而高密度脂蛋白胆固醇
(HDL-C)、载脂蛋白A(ApoA)低于未合并T2DM组(P均<0.05);随访1年发现T2DM合并STEMI组
患者主要不良心血管事件发生率显著高于单纯STEMI组,差异具有统计学意义(P<0.05)。Logistic回
归分析显示,患者STEMI后主要不良心血管事件的发生与PP、LDL-C、GRACE危险评分、Gensini评分正
相关(偏回归系数分别为0.539、0.245、0.092、1.917,P均<0.05)。结论 脉压水平、LDL-C显著影响
STEMI患者的预后,应重视对2型糖尿病合并急性冠脉事件患者脉压水平、血脂的调控。

Abstract:

Objective To investigate the influence of pulse pressure (PP) on prognosis in patients with type
2 diabetes mellitus (T2DM) complicated by acute ST-segment elevation myocardial infarction (STEMI). Methods
STEMI patients (n=125) were chosen from the Fourth Department of Geriatrics in the Seventh Medical Center of
Chinese PLA General Hospital from July 2015 to June 2018, and divided into T2DM+STEMI group (n=56) and STEMI
group (n=69). All patients in 2 groups were given risk scoring by using Global Registry of Acute Coronary Events
(GRACE), and the correlation between risk factors and prognosis was analyzed. Results The risk score of GRACE,
Gensini integrals, PP, mean systolic blood pressure (SBP), fasting plasma glucose (FPG), lycated hemoglobin (HbAlc),
low-density lipoprotein-cholesterol (LDL-C) and apolipoprotein B (ApoB) were all higher in T2DM+STEMI group than
those in STEMI group (all P<0.05). The levels of high-density lipoprotein-cholesterol (HDL-C) and apolipoprotein
A (ApoA) was not lower in T2DM+STEMI group than those in STEMI group (all P<0.05). The incidence rate of major
adverse cardiovascular events (MACE) was significantly higher in T2DM+STEMI group than that in STEMI group
(P<0.05). The results of Logistic regression analysis showed that the incidence of MACE was positively correlated
to PP, LDL-C, GRACE risk score and Gensini score (β=0.539, β=0.245, β=0.092, β=1.917, all P<0.05).
Conclusion PP level and LDL-C can affect significantly the prognosis in STEMI patients, so the controlling of PP
level and blood fat should be paid attention to in patients with T2DM complicated by acute cardiovascular events.

基金项目:

全军十二五资助课题(CWS11J216)

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