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目的探讨糖尿病合并轻中度肾功能不全患者介入诊治术后心功能的影响因素。方法以2008年12月至2011年10月TRACK-D研究中2型糖尿病合并轻中度肾功能不全同时行冠状动脉或外周血管造影的2998例患者为研究对象,采用病例对照研究方法观察介入诊治术后1个月心功能情况,与入院心功能比较,纽约心脏协会(NYHA)分级心功能恶化1级以上判定为心功能恶化,分析影响心功能恶化的相关临床因素。结果 103例(3.4%)在介入诊治术后1个月内发生心功能恶化。恶化组患者年龄≥60岁、高胆固醇血症、心脏超声提示射血分数<50%的比例、洋地黄类药物的使用率、对比剂剂量≥250 m L的使用比例、外周血管造影率及外周血管介入诊疗的发生率均高于正常组(P均<0.05)。正常组围手术期他汀类药物、二氢吡啶类钙离子拮抗剂的使用率高于恶化组(P均<0.05)。多因素分析显示,年龄≥60岁(OR 2.053,95%CI 1.198~3.517,P=0.009)、围手术期应用他汀类药物(OR 0.536,95%CI 0.325~0.902,P=0.018)和二氢吡啶类钙离子拮抗剂(OR 0.360,95%CI 0.198~0.653,P=0.001)以及对比剂剂量≥250 m L(OR 2.263,95%CI 1.236~4.413,P=0.008)是心功能恶化的独立预测因素。结论糖尿病合并轻中度肾功能不全的患者,年龄≥60岁和对比剂使用剂量≥250 m L可能是介入诊疗术后1个月心功能恶化的危险因素,而围手术期应用他汀类药物及二氢吡啶类钙离子拮抗剂则对心功能可能有保护作用。
Objective To investigate the influencing factors of cardiac function after interventional treatment in diabetic patients with mild to moderate renal insufficiency. Methods From December 2008 to October 2011, 2998 patients with type 2 diabetes mellitus complicated with mild to moderate renal dysfunction who underwent coronary angiography or peripheral angiography in the TRACK-D study from December 2008 to October 2011 were enrolled in this study. A case-control study was conducted to evaluate the interventional treatment The cardiac function at 1 month after operation was compared with that at admission, and NYHA cardiac function deterioration at grade 1 or higher was assessed as worsening of cardiac function, and the clinical factors influencing the deterioration of cardiac function were analyzed. Results 103 cases (3.4%) had worsening cardiac function within one month after interventional treatment. Patients in the worsened group were older than 60 years old with hypercholesterolemia, echocardiographic ejection fraction <50%, digitalis use, contrast agent dose ≥ 250 m L, peripheral angiography and peripheral The incidence of vascular intervention were higher than the normal group (all P <0.05). The use of statins and dihydropyridine calcium antagonists in the perioperative period of the normal group was higher than that of the exacerbation group (all P <0.05). Multivariate analysis showed that statin therapy (OR 0.536, 95% CI 0.325-0.902, P = 0.018) and dihydrochloride in the perioperative period (OR 2.053,95% CI 1.198-3.517, P = 0.009) Calcium antagonists of pyridine (OR 0.360, 95% CI 0.198-0.653, P = 0.001) and contrast doses ≥ 250 m L (OR 2.263, 95% CI 1.236-4.413, P = 0.008) were independent of worsening cardiac function Predictors. Conclusion Patients with diabetes mellitus with mild to moderate renal insufficiency, age ≥60 years and contrast agent dose ≥250 m L may be the risk factors of worsening cardiac function one month after interventional therapy. Dihydropyridine calcium antagonists may have a protective effect on cardiac function.