糖尿病患者急性心肌梗死后降糖治疗方案对心血管事件的影响(1)
[摘要]目的 探讨在急性心肌梗死患者中采用不同方案治疗糖尿病的急性心肌梗死复发、充血性心力衰竭及死亡的综合风险。方法 对2015年4月1日～2018年3月31日于上海中医药大学附属岳阳中西医结合医院住院的急性心肌梗死患者进行回顾性队列研究。在1432例急性心肌梗死患者中，无糖尿病患者1006例，无药物治疗糖尿病患者98例，口服降糖药治疗糖尿病患者241例，胰岛素治疗糖尿病患者87例。建立Cox比例风险模型，计算不同糖尿病治疗方案对于急性心梗患者预后的综合风险。结果 糖尿病患者和无糖尿病患者的性别、高血压、心力衰竭和肾脏疾病比较，差异均有统计学意义(P<0.05)。经Cox回归调整年龄和相关因素，结果显示，与非糖尿病患者比较，无药物治疗患者(HR=1.37，95%CI：1.22～1.53)、口服降糖药治疗患者(HR=1.43，95%CI：1.31～1.56)和胰岛素治疗患者(HR=1.65，95%CI：1.48～1.84)结果存在的风险显著增加。结论 胰岛素治疗的糖尿病患者的心血管事件发病率高于口服降糖药治疗的糖尿病患者和非糖尿病患者。
[关键词]胰岛素;糖尿病;心肌梗死;心血管事件
[中图分类号] R541 [文献标识码] A [文章编号] 1674-4721(2020)9(a)-0014-04
[Abstract] Objective To explore the comprehensive risk of acute myocardial infarction recurrence， congestive heart failure and death in patients with acute myocardial infarction using different options to treat diabetes. Methods A retrospective cohort study was conducted on patients with acute myocardial infarction who were hospitalized in Yueyang Hospital of Integrated Traditional Chinese and Western Medicine， Shanghai University of Traditional Chinese Medicine from April 1， 2015 to March 31， 2018. Among the 1432 with acute myocardial infarction， 1006 patients were without diabetes， 98 diabetic patients were without medication， 241 diabetic patients were treated with oral hypoglycemic drugs， and 87 diabetic patients were treated with insulin. A Cox proportional hazard model was established to calculate the comprehensive risk of different diabetes treatment options for the prognosis of patients with acute myocardial infarction. Results The differences in gender， hypertension， heart failure， and kidney disease between diabetic and non-diabetic patients were statistically significant (P<0.05). After adjusting age and related factors by Cox regression， the results showed that compared with non-diabetic patients， there was a significant increase in risk among diabetic patients without medication (HR=1.37， 95%CI：1.22-1.53)， diabetic patients treated with oral hypoglycemic drugs (HR=1.43， 95%CI：1.31-1.56) and insulin-treated patients (HR=1.65， 95%CI：1.48-1.84). Conclusion The incidence of cardiovascular events in insulin-treated diabetic patients is higher than that in diabetic patients treated with oral hypoglycemic drugs and non-diabetic patients.
[Key words] Insulin; Diabetes; Myocardial infarction; Cardiovascular events
在全球范圍内糖尿病患病率日益增高。根据预测，从1995年到2025年世界范围内糖尿病患者将从1.35亿人增加到3亿人，其中75%以上在发展中国家，且在发展中国家糖尿病多发在45～64岁(发达国家多发在65岁以上)[1]。糖尿病和心肌梗死的流行对公共卫生构成了严重的负担[2-3]。2型糖尿病被明确划分为急性心肌梗死(AMI)后不良预后的一个有力的预后标志物[4-5]。到目前为止，胰岛素治疗的糖尿病对心肌梗死和心力衰竭患者的影响，与非胰岛素治疗的患者相比，存在着相互矛盾的数据[6-8]。因此，为了明确糖尿病治疗状态对预后的影响，本研究将所有未接受药物治疗、口服降糖药治疗、胰岛素治疗的AMI患者与未患糖尿病的AMI患者进行了对比分析，比较患者需要住院治疗的死亡率、AMI复发率和充血性心力衰竭(CHF)的综合主要结果，现报道如下。, 百拇医药(万文婷 周菁 崔海明 钱佳 樊民)
[关键词]胰岛素;糖尿病;心肌梗死;心血管事件
[中图分类号] R541 [文献标识码] A [文章编号] 1674-4721(2020)9(a)-0014-04
[Abstract] Objective To explore the comprehensive risk of acute myocardial infarction recurrence， congestive heart failure and death in patients with acute myocardial infarction using different options to treat diabetes. Methods A retrospective cohort study was conducted on patients with acute myocardial infarction who were hospitalized in Yueyang Hospital of Integrated Traditional Chinese and Western Medicine， Shanghai University of Traditional Chinese Medicine from April 1， 2015 to March 31， 2018. Among the 1432 with acute myocardial infarction， 1006 patients were without diabetes， 98 diabetic patients were without medication， 241 diabetic patients were treated with oral hypoglycemic drugs， and 87 diabetic patients were treated with insulin. A Cox proportional hazard model was established to calculate the comprehensive risk of different diabetes treatment options for the prognosis of patients with acute myocardial infarction. Results The differences in gender， hypertension， heart failure， and kidney disease between diabetic and non-diabetic patients were statistically significant (P<0.05). After adjusting age and related factors by Cox regression， the results showed that compared with non-diabetic patients， there was a significant increase in risk among diabetic patients without medication (HR=1.37， 95%CI：1.22-1.53)， diabetic patients treated with oral hypoglycemic drugs (HR=1.43， 95%CI：1.31-1.56) and insulin-treated patients (HR=1.65， 95%CI：1.48-1.84). Conclusion The incidence of cardiovascular events in insulin-treated diabetic patients is higher than that in diabetic patients treated with oral hypoglycemic drugs and non-diabetic patients.
[Key words] Insulin; Diabetes; Myocardial infarction; Cardiovascular events
在全球范圍内糖尿病患病率日益增高。根据预测，从1995年到2025年世界范围内糖尿病患者将从1.35亿人增加到3亿人，其中75%以上在发展中国家，且在发展中国家糖尿病多发在45～64岁(发达国家多发在65岁以上)[1]。糖尿病和心肌梗死的流行对公共卫生构成了严重的负担[2-3]。2型糖尿病被明确划分为急性心肌梗死(AMI)后不良预后的一个有力的预后标志物[4-5]。到目前为止，胰岛素治疗的糖尿病对心肌梗死和心力衰竭患者的影响，与非胰岛素治疗的患者相比，存在着相互矛盾的数据[6-8]。因此，为了明确糖尿病治疗状态对预后的影响，本研究将所有未接受药物治疗、口服降糖药治疗、胰岛素治疗的AMI患者与未患糖尿病的AMI患者进行了对比分析，比较患者需要住院治疗的死亡率、AMI复发率和充血性心力衰竭(CHF)的综合主要结果，现报道如下。, 百拇医药(万文婷 周菁 崔海明 钱佳 樊民)