沙特阿拉伯2型糖尿病患者糖化血红蛋白与经皮冠状动脉介入治疗的结果
Glycated Haemoglobin and Outcomes of Percutaneous Coronary Intervention Among Type Two Diabetic Patients in Saudi Arabia.
作者信息
Albugami Saad, Almehmadi Fahad, Bukhari Ziad M, Alqarni Mohammed S, Abukhodair Abdulkarim W, BinShihon Malak A, Al-Husayni Faisal, Alhazzani Razan A, AlMatrafi Samah A, Makki Khalid
机构信息
Cardiology, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.
Cardiology, King Faisal Cardiac Center, King Abdulaziz Medical City, Jeddah, SAU.
出版信息
Cureus. 2020 Oct 31;12(10):e11278. doi: 10.7759/cureus.11278.
BACKGROUND
Glycated haemoglobin (HbA1c) is a marker that reflects the control of diabetes mellitus (DM) over a three-month period. We sought to compare cardiovascular outcomes of diabetic patients with and without controlled levels of HbA1c post percutaneous coronary intervention (PCI) presenting to King Faisal Cardiac Center. Methods: A retrospective single-center study of all patients with type two DM who were treated with PCI during the period between January 2015 and January 2018. All data were obtained from health informatics system. Demographics, clinical data, and major adverse cardiovascular and cerebrovascular events (MACCE) were collected to compare outcomes among diabetic patients with and without controlled HbA1c.
RESULTS
The study included 177 patients with type two DM who underwent PCI. The mean age was 63.3 (SD±12). Males represented 73.4% and 26.6% were females. The mean HbA1c on admission was 8.7%. At presentation 31% of the patients had relatively controlled blood sugar (HbA1c mean 7.5%, SD±0.5) and 69% presented with poorly controlled type two DM (mean HbA1c 9.1%, SD±0.25). The prevalence of hypertension and dyslipidaemia were higher among the uncontrolled group, but there were no differences between both groups in the control of blood pressure or dyslipidaemia. Patients in the uncontrolled group had higher rate of prior PCI (36.6%) compared to the controlled arm (16%, p=0.0195) The prevalence of cerebrovascular, cardiovascular, and renal impairment was similar. The use of insulin was higher among the uncontrolled arm. Patients in the controlled arm had lower incidence of composite endpoints of death and non-fatal myocardial infarction and stroke (MACCE) (14% vs 41%, p=0.001) compared to the uncontrolled arm.
CONCLUSION
Among patients with type two DM that were treated with PCI, achieving targets of blood sugar control reflected by glycated haemoglobin is associated with improved survival and lower incidence of composite MACCE.
背景
糖化血红蛋白（HbA1c）是反映糖尿病（DM）三个月内控制情况的指标。我们试图比较在费萨尔国王心脏中心接受经皮冠状动脉介入治疗（PCI）的糖尿病患者中，糖化血红蛋白水平得到控制和未得到控制的患者的心血管结局。
方法
对2015年1月至2018年1月期间接受PCI治疗的所有2型糖尿病患者进行回顾性单中心研究。所有数据均从健康信息系统中获取。收集人口统计学、临床数据以及主要不良心血管和脑血管事件（MACCE），以比较糖化血红蛋白得到控制和未得到控制的糖尿病患者的结局。
结果
该研究纳入了177例接受PCI治疗的2型糖尿病患者。平均年龄为63.3岁（标准差±12）。男性占73.4%，女性占26.6%。入院时糖化血红蛋白的平均值为8.7%。就诊时，31%的患者血糖相对得到控制（糖化血红蛋白平均值7.5%，标准差±0.5），69%的患者2型糖尿病控制不佳（糖化血红蛋白平均值9.1%，标准差±0.25）。未得到控制的组中高血压和血脂异常的患病率较高，但两组在血压或血脂异常的控制方面没有差异。与得到控制的组（16%，p = 0.0195）相比，未得到控制的组中既往接受PCI的比例更高（36.6%）。脑血管、心血管和肾脏损害的患病率相似。未得到控制的组中胰岛素的使用更为频繁。与未得到控制的组相比，得到控制的组中死亡、非致命性心肌梗死和中风的复合终点（MACCE）的发生率更低（14%对41%，p = 0.001）。
结论
在接受PCI治疗的2型糖尿病患者中，实现糖化血红蛋白所反映的血糖控制目标与生存率提高以及复合MACCE发生率降低相关。
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