糖尿病合併冠狀動脈疾病－從藥物治療至血管重建之綜論

Diabetes with Coronary Heart Disease -from Medication to Revascularization

彭柏森(Po-Sen Peng) ； 劉開璽(Kai-Hsi Liu) ； 蔡宗能(Tsung-Neng Tsai) ； 鄭正忠(Cheng-Chung Cheng) ； 林維祥(Wei-Shiang Lin)

《內科學誌》 30卷4期 (2019/08) Pp. 229-238

https://doi.org/10.6314/JIMT.201908_30(4).01

摘要

冠狀動脈疾病（coronary heart disease）是糖尿病患者死亡的主要原因，而糖尿病患者亦常併發心血管疾病，等同於冠狀動脈心臟病的高危險群（coronary heart disease risk equivalent），故愈早將糖化血色素控制在理想值內，就愈能減少相關併發症的發生。近年來糖尿病藥物蓬勃發展，許多藥物不僅可改善血糖控制，更可減少不良心血管事件的發生。而冠狀動脈疾病治療的血管重建，包括經皮冠狀動脈介入治療 （percutaneous coronary intervention，PCI）及冠狀動脈繞道手術（coronary artery bypass graft，CABG）其預後於糖尿病患者皆較差。本文回顧糖尿病藥物之許多指標性的心臟血管結果試驗（cardiovascular outcomes trial），並回顧相關文獻，比較經皮冠狀動脈介入治療及冠狀動脈繞道手術於糖尿病患者之優劣，以期能增加內科醫師於糖尿病合併冠狀動脈疾病治療之認識。

關鍵字

糖尿病（Diabetes mellitus） ； 糖尿病藥物（Anti-diabetic agents） ； 冠狀動脈疾病（Coronary heart disease） ； 經皮冠狀動脈介入治療（Percutaneous coronary intervention, PCI） ； 冠狀動脈繞道手術（Coronary artery bypass grafting, CABG）

並列摘要

Coronary heart disease is the leading cause of death in diabetic patients, and diabetic patients often have cardiovascular disease. Diabetes mellitus is equivalent to high risk of coronary heart disease, so the sooner glycosylated hemoglobin keeps within the ideal value, the more the related complications can be reduced. In recent years, diabetes drugs have vigorous development, and many drugs can not only improve blood sugar control, but also reduce the incidence of adverse cardiovascular events. Revascularization in the treatment of coronary artery disease, including percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG), has a poorer prognosis in patients with diabetes. This review article provides an exhaustive overview of many landmark cardiovascular outcomes trials of diabetes drugs and relevant literature to compare the advantages and disadvantages of PCI and CABG in patients with diabetes, in order to increase the understanding of the treatment for diabetes mellitus combined with coronary heart disease.