在胰岛素依赖,患有慢性功能衰竭的糖尿病患者中冠状动脉复血管化
1Department of Medicine, University of Minnesota, School of Medicine, Minneapolis.
Lancet (London, England)
|October 24, 1992
概括
在胰岛素依赖的糖尿病患者,慢性功能衰竭和无症状冠状动脉疾病患者中,冠状动脉再血管化显著减少心脏事件. 对于这些患者,建议对静音冠状动脉疾病进行查.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 糖尿病学 糖尿病学
背景情况:
- 接受移植评估的胰岛素依赖型糖尿病患者往往患有显著的冠状动脉疾病 (CAD).
- 在这个人群中,大量的CAD与2年生存率差 (<50%) 相关.
- 在这些患者中,无症状或最小症状的CAD的管理是有争议的.
研究的目的:
- 调查冠状动脉复血管化是否减少不稳定性心痛,心肌梗塞和心脏死亡的综合发病率.
- 评估重血管化与医疗管理对被选中的糖尿病移植候选人的心血管结果的影响.
主要方法:
- 对151名胰岛素依赖的糖尿病移植候选人进行了冠状动脉造血.
- 确定了31名患有严重CAD (狭窄症>75%),非典型/没有胸痛和保存的喷射分数的患者.
- 26名患者被随机分配到医疗治疗 (通道阻塞剂+阿司匹林) 或再血管 (血管造形/旁路手术) 中.
主要成果:
- 与医疗管理相比,再血管化显著降低了心血管终点 (2/13 vs 10/13患者,p < 0.01).
- 医疗管理与较高的心血管事件发生率有关,包括4例死于心肌梗塞的死亡.
- 随访时间中位数为8.4个月.
结论:
- 在胰岛素依赖的糖尿病患者中,冠状动脉再血管似乎会降低慢性功能衰竭和无症状严重冠状动脉狭窄症的心脏病发病率和死亡率.
- 对于正在考虑进行移植的糖尿病患者,建议对静音冠状动脉疾病进行查.
- 再血管化可能是这种高风险人群的有益策略.
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