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发病率和死亡率相关CAD仍然是对糖尿病患者的巨大挑战。糖尿病的血小板功能异常,两个糖蛋白Ⅰb和Ⅱb/Ⅲa受体的表达增加,使扩张血小板血管性假血友病因子和血小板纤维蛋白相互作用,而导致糖尿病患者死亡和血栓性并发症的风险增加。多项研究表明:成功进行PCI后血管再建更需反复,临床疗效差,DM仍然是一个极高的危险因素。虽然资料表明,药物洗脱支架(DES)可减少阻塞率及重复再建血管与糖尿病状况无关,但治疗的终点结果如心肌梗塞,死亡率没有实质上的减少。然而,也有许多其他随机试验比较多支的PCI使用DES或金属裸支架(BMS)跟冠状动脉搭桥术(CABG),冠状动脉搭桥术优越性对糖尿病患者一直具有优越性。糖尿病患者和多支冠状动脉病变,选择最优策略心肌血运重建是至关重要的。血运重建策略必须考虑到狭窄和移植物闭塞的风险较高,以及病后遗症使糖尿病的介入治疗复杂化。当选择PCI时,应倾向于使用DES和强有力的血小板抑制剂。当选择冠状动脉搭桥术时,要考虑在围术期脑卒中的减少,伤口感染的减少,手术后的医疗管理的优化选择时,要有利于糖尿病患者。患者的血糖控制有利于这两个策略。
The morbidity and mortality-related CAD remains a huge challenge for people with diabetes. Diabetic platelets are dysfunctional and the expression of two glycoprotein Ib and IIb / IIIa receptors is increased, causing dilated platelet von Willebrand factor to interact with platelet fibrin leading to the risk of death and thrombotic complications in diabetic patients increase. A number of studies have shown that: the successful revascularization of the PCI need more repeated, poor clinical efficacy, DM is still a very high risk factor. Although data suggest that drug-eluting stents (DES) reduce the rate of obstruction and reproduce blood vessels unrelated to the condition of diabetes, end-of-treatment outcomes such as myocardial infarction do not result in a substantial reduction in mortality. However, there are many other randomized trials comparing PCI with DES or bare metal stent (BMS) with coronary artery bypass grafting (CABG). The superiority of coronary artery bypass grafting has always been superior in patients with diabetes. Diabetic patients and multiple coronary lesions, the optimal choice of myocardial revascularization is crucial. The revascularization strategy must take into account the high risk of stenosis and graft occlusion, as well as the complications that complicate the interventional treatment of diabetes. When choosing PCI, it should be tempting to use DES and potent platelet inhibitors. When choosing coronary artery bypass surgery, to consider in the reduction of stroke during perioperative, wound infection reduction, the optimal choice of medical management after surgery, to be beneficial to patients with diabetes. Patients’ glycemic control favors both strategies.