摘要
目的探讨二甲双胍+吡格列酮方案对冠心病伴糖尿病病人药物洗脱支架置入(DES)术后管腔再狭窄程度、主要心血管不良事件(MACE)及内皮祖细胞水平的影响。方法选取葛洲坝集团中心医院2016年1月至2017年12月收治行DES术冠心病伴糖尿病病人共130例,以随机数字表法分为对照组(65例)和观察组(65例),对照组病人给予二甲双胍口服,0.5克/次,1次/天;观察组病人在此基础上加用吡格列酮口服,15毫克/次,1次/天。两组病人均连续用药12个月。比较两组病人管腔再狭窄发生率,晚期血管充盈缺失值,治疗前后最小血管直径、直径狭窄率、外周血内皮祖细胞、血糖水平及随访MACE发生率。结果观察组病人管腔再狭窄发生率和晚期血管充盈缺失值分别为0.00%,(0.20±0.06)mm,均显著低于对照组的9.23%,(0.36±0.09)mm(P<0.05);观察组病人治疗后最小血管直径为(2.84±0.56)mm,显著高于对照组的(2.18±0.42)mm(P<0.05);观察组病人治疗后直径狭窄率为(10.05±1.49)%,显著低于对照组的(25.16±3.72)%、治疗前的(80.76±10.99)%(P<0.05)。观察组病人随访MACE发生率为1.54%,显著低于对照组的10.77%(P<0.05);观察组病人治疗后糖化血红蛋白(HbA1c)和空腹血糖水平分别为(6.40±0.87)%、(8.14±0.66)mmol/L,均显著低于对照组的(7.06±1.09)%、(9.01±0.80)mmol/L,治疗前的(7.51±1.20)%、(9.90±1.06)mmol/L(P<0.05);同时观察组病人治疗后CD34和CD113水平分别为(11.17±1.60)%、(29.25±3.10)%,均显著高于对照组的(9.46±1.29)%、(25.03±2.28)%,治疗前的(7.50±0.99)%、(20.70±1.82)%(P<0.05)。结论二甲双胍+吡格列酮方案用于行DES术冠心病伴糖尿病病人可有效改善远期管腔狭窄程度,降低血糖水平,并有助于避免MACE发生。
Objective To explore the influence of metformin+pioglitazone scheme on the restenosis degree,major adverse cardiac events(MACE)and endothelial progenitor cells of patients with coronary heart disease and diabetes after the implantation of a drugeluting stent(DES).Methods A hundred and thirty patients with coronary heart disease and diabetes undergoing DES in Gezhouba Group Central Hospital in the period from January 2016 to December 2017were chosen and randomly assigned into 2 groups:control group(65 patients)treated with metformin(0.5 g once a day)and observation group(65 patients)with metformin(0.5 g once a day)+pioglitazone(15 mg once a day).Both groups were treated continuously for 12 months and a comparison was made of the incidences of luminal restenosis,vascular loss values in late stage,the minimum vessel diameters,diameter stenosis rates,the levels of peripheral blood endothelial progenitor cells and blood glucose before and after treatment and the incidences of MACE with follow-up between the two groups.Results The incidence of luminal restenosis and vascular loss value in late stage of observation group were significantly lower than those of control group[0.00%vs.9.23%,(0.20±0.06)mm vs.(0.36±0.09)mm;P<0.05].The minimum vessel diameter of observation group after treatment was significantly wider than that of control group[(2.84±0.56)mm vs.(2.18±0.42)mm,P<0.05].The diameter stenosis rate of observation group after treatment[(10.05±1.49)%]was significantly lower than that of control group[(25.16±3.72)%]and that before treatment[(80.76±10.99)%](P<0.05).The incidence of MACE with follow-up of observation group was significantly lower than that of control group(1.54%vs.10.77%,P<0.05).The levels of hemoglobin A1c(HbA1c)and fasting plasma glucose(FPG)of observation group after treatment[(6.40±0.87)%,(8.14±0.66)mmol/L]were significantly lower than those of control group[(7.06±1.09)%,(9.01±0.80)mmol/L]and those before treatment[(7.51±1.20)%,(9.90±1.06)mmol/L](P<0.05).The levels of CD34 and CD133 of observation group after treatment[(11.17±1.60)%,(29.25±3.10)%]were significantly higher than those of control group[(9.46±1.29)%,(25.03±2.28)%]and those before treatment[(7.50±0.99)%,(20.70±1.82)%](P<0.05).Conclusion Metformin+pioglitazone scheme in the treatment of patients with coronary heart disease and diabetes after DES can efficiently improve the lumen stenosis degree for long term,reduce the blood glucose level and be helpful to avoid the occurrence of MACE.
作者
孙莉萍
孟军
SUN Liping;MENG Jun(Nuclear Medicine Department,Gezhouba Group Central Hospital,Yichang,Hubei 443002,China)
出处
《安徽医药》
CAS
2021年第12期2496-2499,共4页
Anhui Medical and Pharmaceutical Journal
