慢性腎不全のインスリン依存型糖尿病患者における冠動脈再血管化は
1Department of Medicine, University of Minnesota, School of Medicine, Minneapolis.
Lancet (London, England)
|October 24, 1992
まとめ
冠動脈再血管化は,慢性腎不全と無症状の冠動脈疾患を有するインスリン依存型糖尿病患者の心臓病を有意に減少させた. これらの患者には静かな冠動脈疾患のスクリーニングが推奨されます.
科学分野:
- 心臓病学 心臓病学
- ネフロロジーはネフロロジーを用います.
- 糖尿病学 糖尿病学
背景:
- 腎臓移植の評価を受けているインスリン依存型糖尿病患者は,しばしば重大な冠動脈疾患 (CAD) を有する.
- この集団における実質的なCADは,2年生存率の低下 (<50%) と関連しています.
- これらの患者の無症状または最小症状のCADの管理は論争の的です.
研究 の 目的:
- 冠動脈再血管化は,不安定なアンギナ,心筋梗塞,心疾患による死亡の合併的発生率を減少させるかどうかを調査する.
- 選択された糖尿病性腎臓移植候補者における心血管疾患のアウトカムに対するリヴァスキュラライゼーションと医療管理の影響を評価する.
主な方法:
- 冠動脈血管図は,腎臓移植の候補であるインスリン依存型糖尿病患者151人に実施されました.
- 31人の重度のCAD (狭窄症 >75%),非典型的/無胸痛,および噴出分子が保存された患者が特定されました.
- 26人の患者がランダムに治療 (カルシウムチャネルブロッカー+アスピリン) または再血管化 (血管新生手術/バイパス手術) に割り当てられました.
主要な成果:
- 再血管化は,医療管理と比較して,心血管のエンドポイントを著しく低下させました (2/13対10/13患者,p <0.01).
- 医療管理は,心筋梗塞による4件の死亡を含む,心血管疾患の発生率の高さに関連していました.
- 追跡期間の中央値は8.4ヶ月でした.
結論:
- 冠動脈再血管化は,慢性腎不全および無症状の重症冠動脈狭窄症のインスリン依存型糖尿病患者の心疾患および死亡率を低下させるようです.
- 静かな冠動脈疾患のスクリーニングは,腎臓移植を検討されている糖尿病患者のために推奨されます.
- 再血管化は,この高リスク集団にとって有益な戦略である可能性があります.
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