References

diaendo

Сахарный диабет

Diabetes mellitus

2072-03512072-0378

Endocrinology research centre

10.14341/2072-0351-6052

diaendo-6052

Research Article

Статьи

Articles

Реваскуляризация миокарда у больных сахарным диабетом

Myocardial revascularization in diabetic patients

Дедов

Иван Иванович

Dedov

Ivan Ivanovich

Терёхин

Сергей Анатольевич

Terekhin

Sergey Anatol'evich

doctserg@yandex.ru

ФГУ Эндокринологический научный центр, МоскваEndocrinology Research Centre, Moscow

2010

15122010

134

№4 (2010)

1823

2010

Дедов И.И., Терёхин С.А.

Dedov I.I., Terekhin S.A.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.dia-endojournals.ru/jour/article/view/6052

Больные сахарным диабетом (СД) предрасположены к диффузной и быстро прогрессирующей форме атеросклероза, что значительноувеличивает вероятность хирургической реваскуляризации миокарда. Тем не менее, уникальная патофизиология атеросклероза у паци-ентов с СД изменяет ответ на повреждение артерии вследствие чрескожного коронарного вмешательства (ЧКВ). Многочисленные ис-следования показали, что СД является независимым фактором риска развития рестеноза после успешной баллонной ангиопластики илистентирования коронарных артерий, значимо повышает потребность в повторной реваскуляризации миокарда и ухудшает клиническиеисходы. Предварительные данные показывают, что стенты, выделяющие лекарство, уменьшают потребность в повторных вмеша-тельствах, независимо от наличия у пациента СД, без значительного ухудшения показателей клинических конечных точек, таких какинфаркт миокарда и смертность. Многие пациенты с I или II функциональным классом стенокардии напряжения не получат улучшенияклинической картины или прогноза от любого хирургического вмешательства по сравнению с оптимальной медикаментозной терапией.Хирургическая реваскуляризация, ЧКВ или аорто-коронарное шунтирование (АКШ) подходят для пациентов, которые остаются симп-томными, несмотря на адекватную консервативную терапию. Тем не менее, выбор оптимальной стратегии реваскуляризации миокардау пациентов с СД и имеющих многососудистое поражение коронарного русла является решающим. Рандомизированные исследования,сравнивающие многососудистое ЧКВ с баллонной ангиопластикой или голо-металлическими стентами продемонстрировали превосход-ство АКШ у больных с СД. Больные, перенесшие АКШ, имели лучшую выживаемость, меньшее количество инфарктов и повторной ре-васкуляризации. Ограниченные данные показывают, что АКШ превосходит многососудистое ЧКВ даже тогда, когда используютсястенты, выделяющие лекарство. Несколько текущих рандомизированных исследований, сравнивающих долгосрочные результаты эф-фективности ЧКВ со стентами, выделяющими лекарство, и АКШ, возможно, покажут оптимальную стратегию реваскуляризациимиокарда у пациентов с СД.

Patients with diabetes mellitus (DM) are predisposed to diffuse and rapidly progressing forms of atherosclerosis which significantly increasesthe probabilityof surgical revascularization of myocardium. However, unique pathophysiological features of atherosclerosis in DM patients are responsiblefortheirunusual reaction to an arterial injury associated with percutaneous coronary intervention (PCI).Numerousstudies showed that DM is an independentrisk factor of restenosis following successful balloon angioplasty or stenting of coronary arteries and significantly increases the need forsecondary myocardial revascularization that compromises the outcome of the treatment.Preliminary data indicate that the use of drug-releasing stentsdecreases the need for repeat interventions in both diabetic and non-diabetic patients without negative effect on certain clinical end-points, such asmyocardial infarction and mortality. Any surgical intervention causes less pronouncedimprovement of the clinical picture or prognosis in patients withfunctional class I or II angina of effort compared with optimal medicamental therapy. Surgical revascularization, PCI and aortocoronary bypasssurgery (ACB) is indicated to patients that remain symptomatic despite adequate conservative therapy. The choice of an optimal revascularizationstrategy is of primary importance for DM patients with multiple lesions in the coronary system. Randomized studies comparing multivascularPCI withballoon angioplasty and holometallic stents demonstrated the advantage of ACB for DM patients who showed a higher survival rate, lower frequencyof infarctions and secondary revascularization. Certain authors demonstrated that ACB surpasses PCI even when drug-releasing stents are used.It may be hoped that the ongoing randomized studies comparing the two modalities will help to develop the optimal strategy for myocardial revascularizationindiabetic patients.

сахарный диабетреваскуляризация миокардарестеноз

diabetes mellitusmyocardial revascularizationrestenosis

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The authors declare that there are no conflicts of interest present.