Kazakov Iu I, Kas'ianenko A P, Sokolova N Iu, Bakulina A V, Iakovlev A O
Department of Cardiovascular Surgery, Tver State Medical University of the RF Ministry of Public Health, Tver, Russia; Cardiosurgery Department No 2, Regional Clinical Hospital, Tver, Russia.
Cardiosurgery Department No 2, Regional Clinical Hospital, Tver, Russia.
Angiol Sosud Khir. 2017;23(2):98-106.
The authors comparatively analysed the remote results of carotid endarterectomy and risk factors for unfavourable outcomes in patients with and without type 2 diabetes mellitus (DM). The outcomes of carotid endarterectomy were studied in a total of 168 patients, with the follow-up terms up to 8 years. Depending on the presence or absence of DM, the patients were divided into two groups. Group One comprised 79 patients with an atherosclerotic lesion of the internal carotid artery and accompanying DM, with Group Two consisting of 89 non-diabetic patients. There were no lethal outcomes in the early postoperative period. The composite measure 'lethality + stroke' in Group One amounted to 2.5% and in Group Two to 2.2%. In the remote period the survival rate was as follows: 65 (82.3%) people for Group One and 83 (93.3%) for Group Two, with the 5-year cumulative survival rate amounting to 75.1±6.4% and 92.5±3.0%, respectively. The index of freedom from acute vascular complications (myocardial infarction, ischaemic stroke) at 5 years in Group One was 54.2±7.2% and in Group Two 86.1±4.3%. Acute vascular complications were causes of lethal outcomes in 13 cases in the group with DM and in 3 cases in the group without DM. Death was most often caused by acute coronary complications. The index of freedom from restenosis at 5 years in Group One amounted to 74.5±8.0% and at 7 years of follow-up in Group Two to 92.3±7.3%. The risk factors for the development of acute vascular complications in diabetic patients according to the findings of the Cox regression analysis were as follows: age above 65 years, DM duration of more than 5 years; the level of glycated haemoglobin above 7.5%; a history of myocardial infarction; presence of degree III arterial hypertension. The risk factors for restenosis included: DM duration of more than 5 years, the level of glycated haemoglobin above 7.5% and presence of degree III arterial hypertension. The results of the study make it possible to regard carotid endarterectomy efficient and safe for both cohorts of patients (with and without DM). In the remote postoperative period, such parameters as survival rate, indices of freedom from acute vascular complications and restenosis turned out to be statistically significantly lower in diabetic patients than in non-diabetic, with the predominating coronary complications induced by insufficient assessment of the coronary reserve and the presence of occult forms of ischaemic heart disease. Long-term results may be improved by means of widening the indications for performing coronarography in patients with DM.
作者比较分析了有和没有2型糖尿病（DM）患者的颈动脉内膜切除术远期结果及不良结局的危险因素。共对168例患者的颈动脉内膜切除术结果进行了研究，随访时间长达8年。根据是否患有DM，将患者分为两组。第一组包括79例伴有DM的颈内动脉粥样硬化病变患者，第二组由89例非糖尿病患者组成。术后早期无死亡病例。第一组“死亡+卒中”的综合指标为2.5%，第二组为2.2%。远期生存率如下：第一组65例（82.3%），第二组83例（93.3%），5年累积生存率分别为75.1±6.4%和92.5±3.0%。第一组5年时无急性血管并发症（心肌梗死、缺血性卒中）的指标为54.2±7.2%，第二组为86.1±4.3%。急性血管并发症是DM组13例和非DM组3例死亡的原因。死亡最常见的原因是急性冠状动脉并发症。第一组5年时无再狭窄的指标为74.5±8.0%，第二组随访7年时为92.3±7.3%。根据Cox回归分析结果，糖尿病患者发生急性血管并发症的危险因素如下：年龄超过65岁、DM病程超过5年、糖化血红蛋白水平高于7.5%、有心肌梗死病史、存在III级动脉高血压。再狭窄的危险因素包括：DM病程超过5年、糖化血红蛋白水平高于7.5%和存在III级动脉高血压。研究结果表明，颈动脉内膜切除术对两组患者（有和无DM）都是有效且安全的。在术后远期，糖尿病患者的生存率、无急性血管并发症和再狭窄的指标在统计学上显著低于非糖尿病患者，主要的冠状动脉并发症是由于对冠状动脉储备评估不足和存在隐匿性缺血性心脏病形式所致。通过扩大DM患者进行冠状动脉造影的适应症，可能会改善长期结果。
