NEJM：外科手术或是糖尿病患者心脏疾病的更佳治疗手段

2012年11月6日 --近日，刊登在国际著名杂志New England Journal of Medicine上的一篇研究报告“Compelling Evidence for Coronary-Bypass Surgery in Patients with Diabetes”中，来自国外的研究者通过研究揭示了，糖尿病病人进行心脏搭桥手术或优于在血管中通过开阔血管搭支架的方式来进行手术。

研究者通过对1900项糖尿病患者进行研究、分析以及比较，并且在未来五年中观察患者的情况，以确定多少患者会发生心脏病、中风和死亡。

长期观察研究结果表明，心脏搭桥手术的糖尿病患者出现上述风险的比例为19%，而进行支架手术的患者发病风险的比例为27%。

此项研究中的心脏病患者占到了所有心脏病病人的四分之一，这项研究成果将于周日在美国心脏协会会议上进行研究讨论。

通过进行此项研究，研究者揭示了，外科手术或许是糖尿病患者进行心脏疾病治疗的最佳手段

与糖尿病相关的拓展阅读：

• JAMA：研究支持对糖尿病患者进行更强力的抗血小板治疗
• Obes Surg：减重手术可能不能“治愈”糖尿病
• Cell Metab:新的血清标志物提前数年预测糖尿病风险
• Circulation：精氨酸酶抑制剂治疗糖尿病患者并发症
• Diabetologia：维生素D缺乏与1型糖尿病
• JBC：维生素D或可抑制糖尿病患者动脉的阻塞
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Compelling Evidence for Coronary-Bypass Surgery in Patients with Diabetes

Seventeen years ago, the National Heart, Lung, and Blood Institute issued a clinical alert1 that coronary-artery bypass grafting (CABG) had better rates of survival than percutaneous coronary intervention (PCI) in patients with diabetes. The alert was based on the results of the Bypass Angioplasty Revascularization Investigation (BARI) trial,2 in which patients with multivessel coronary artery disease were randomly assigned to undergo either CABG or PCI. This recommendation has been controversial ever since, largely because subsequent trials comparing CABG and PCI have enrolled only small numbers of patients with diabetes. A pooled analysis of 10 randomized trials involving 1233 patients with diabetes confirmed that such patients had a particular survival advantage after CABG, as compared with PCI.3 But this evidence was discounted because drug-eluting stents were not used in PCI procedures in the earlier trials, and more recent trials in which drug-eluting stents were used4,5 enrolled relatively few patients with diabetes. Settling this controversy would require a trial with a large number of patients with both diabetes and multivessel coronary artery disease in whom CABG or PCI would be performed with the use of contemporary methods.