今回は冠動脈バイパス手術を行った
日本人患者の転帰における
血糖コントロールの影響を検討した文献です。
糖尿病患者849名と非糖尿病者572名に対し
脈バイパス手術後の心血管イベント、感染症、死亡率
の比較を行っています。
There have been no large-scale studies on the impact of diabetes mellitus (DM) on outcomes in Japanese patients undergoing coronary artery bypass grafting (CABG).
A multi-institutional retrospective cohort study was conducted in 14 Japanese centers. All adult patients who underwent isolated CABG from 2007 to 2008 were included (n = 1522, mean age: 68.5 years). The definitions of DM were all patients admitted with diagnosis of DM and preoperative glycated hemoglobin (Hb) A1c ≥ 6.5%. Univariate and multivariate analyses were performed to identify the risk of morbidity and mortality.
There were 849 DM and 572 non-DM patients. Preoperative mean HbA1c were 7.1% in the DM group and 5.7% in the non-DM group (p < 0.0001). Preoperative, intraoperative, and 3-day average postoperative blood glucose (BG) were 146 mg/dl, 172 mg/dl, and 168 mg/dl in the DM group, and 103 mg/dl, 140 mg/dl, and 136 mg/dl in the non-DM group (all p < 0.0001). Although there were no significant differences in postoperative cardiovascular events, the incidence of infection was significantly higher in the DM group than in the non-DM group (9.2% vs 6.1%, p = 0.036) on the univariate analysis. The all-cause death was also relatively higher in the DM group than in the non-DM group (2.1% vs 1.1%, p = 0.12), and this was likely related to infection.
DM patients had worse perioperative BG control, higher incidence of infection, and higher mortality than non-DM patients. These results indicate that perioperative BG control guidelines should be standardized to obtain better surgical outcomes in Japanese DM patients.
結果は術前の平均HbA1cは糖尿病患者で7.1％
非糖尿病者で5.7%だった。
術後の心血管イベントに有意差は認められなかったが
感染症の発症率は糖尿病患者で有意に高かった。
死亡率には有意差は無かった。
結論として糖尿病患者は術前の血糖コントロールが不良
であり、感染症の発症率は
非糖尿病者と比較し有意に高かったということです。
引用文献
Minakata K, Bando K, Takanashi S, et al
Impact of diabetes mellitus on outcomes in Japanese patients undergoing coronary artery bypass grafting
J Cardiol 2012; 59: 275–284