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目的运用倾向性评分匹配法(PSM),分析胰岛素对冠心病(CHD)伴2型糖尿病(DM)支架置入术后再狭窄(ISR)的影响。方法搜集本院2006年1月至2009年4月接受冠状动脉支架置入术的137例DM患者;根据是否使用胰岛素分为胰岛素组57例,对照组80例。运用PSM对两组患者采用1∶1最邻近匹配法,得到组间协变量均衡的样本。匹配后的样本采用COX比例风险模型评估支架术后再狭窄的危险因素。结果两组共有36对患者匹配成功,匹配后的两组患者在一般临床资料比较中无统计学差异。胰岛素组中1、3、5年的累计狭窄率分别为21.7%、59.6%和59.6%,对照组为9.1%、37.7%和45.2%,经log-rank检验,差异存在统计学意义(P=0.032)。经COX比例风险模型多因素分析发现,吸烟史(HR:2.32,95%CI:1.35~4.31,P=0.008)、糖化血红蛋白>7.5%(2.27,1.26~3.68,0.031)、总胆固醇>5.0 mmol/L(1.89,1.18~3.57,0.034)、肌酐清除率>90 ml/min(0.36,0.21~0.88,0.027)、冠状动脉多支病变(2.26,1.18~4.29,0.024)和胰岛素治疗(2.27,1.09~4.15,0.041)是CHD伴DM支架术后ISR的独立因素。结论对于伴有DM的CHD患者,胰岛素治疗是支架置入术ISR的独立危险因素。
Objective To analyze the effect of insulin on restenosis (ISR) after coronary stentomy with coronary heart disease (CHD) and type 2 diabetes mellitus (DM) using propensity score matching (PSM). Methods A total of 137 patients with DM undergoing coronary stent implantation from January 2006 to April 2009 were enrolled in this study. According to whether insulin was used, 57 cases were divided into insulin group and 80 cases in control group. PSM was used to compare the two groups of patients using the 1: 1 nearest neighbor matching method to obtain covariates between groups. Matched samples were used to assess risk factors for stent restenosis using the COX proportional hazards model. Results A total of 36 pairs of patients in both groups were matched successfully. There was no significant difference between the two groups in the general clinical data after matching. The 1,3,5-year cumulative rates of stenosis in the insulin group were 21.7%, 59.6%, and 59.6%, respectively, and 9.1%, 37.7%, and 45.2% in the control group, respectively. 0.032). Cox proportional hazard model multivariate analysis showed that smoking history (HR: 2.32, 95% CI: 1.35-4.31, P = 0.008), HbA1c> 7.5% (2.27,1.26 ~ 3.68,0.031), total cholesterol> 5.0 mmol Creatinine clearance> 90 ml / min (0.36,0.21 ~ 0.88,0.027), multiple coronary artery disease (2.26,1.18 ~ 4.29,0.024) and insulin treatment (2.27, 1.09 ~ 4.15,0.041) is an independent factor of ISR after CHD with DM stent. Conclusion Insulin treatment is an independent risk factor for stent-graft ISR in CHD patients with DM.