| Research background:Studies have confirmed type 2 diabetes mellitu s as an independent risk factor for the development of coronary heart disease(CHD),and CHD has been identified as the leading cause of death in type 2 diabetes mellitus.It has been suggested that even asymptomatic diabetes could be a potential risk factor for early ischemic heart disease.Studies suggest tha t the risk of death associated with cardiovascular events in diabetes is far high er than that associated with diabetes itself.Specifically,myocardial infarction is the most common cause of death among diabetic patients,70% of whom wo uld die of myocardial infarction.In recent years,CHD has surpassed infectious diseases to become the leading cause of human death.At present,coronary ar tery bypass graft(CABG)is the preferred therapeutic option for patients wit h severe CHD;however,with the increasing application of CABG,the impact of the postoperative complications(renal injury in particular)on the patient's postoperative quality of life and survival has become evident,especially when considering the large number and special condition of CHD patients with diabe tes.Acute kidney injury(AKI)is a clinical syndrome that is a common posto perative complication of CABG for CHD,and has significant impact on postop erative fluid-electrolyte balance and general condition of the patient.Studies ha ve indicated the significant role of AKI in CHD recurrence.To date there have been limited studies of the effects of type 2 diabetes mellitus on the postop erative complications of CABG for CHD patients with type 2 diabetes mellitus. In this study,we therefore evaluated the effects of type 2 diabetes mellitus o n the postoperative complications of off-pump CABG for patients with CHD,a nd analyzed their association.Methods:Totally 909 patients,treated with off-pump external coronary a rtery bypass graft between December 12,2011 and September 2016,were incl uded.Of them,there were 680 male patients and 229 female ones,aged 63.8±8.37 on average.The included patients who were complicated by type 2 dia betes totaled to 327,with 136 ones orally administrated acarbose and glimepiri de for blood glucose reduction(medication of metformin was forbidden one w eek prior to operation)and 201 ones treated with insulin injection(due to und esirable control of state of illness,23 ones were treated with subcutaneous ins ulin pump after consultation with the Department of Endocrinology).For all th e patients,preoperative preparation was completed one week prior to the opera tion and the fasting blood glucose was steadily kept 6.0-8.0mmol/L.Because15 patients died of preoperative massive myocardial infarction,postoperative pulm onary infection or circulatory failure,their biochemical indexes were abnormal and thus excluded(a gross death rate of 1.65%).According to preoperative ECG examinations among the remaining patients,unexceptionally they featured sinus rhythm;no pulmonary inflammation detected through chest radiography and chest CT;the serum electrolytes were within normal range according to bi ochemical assay;normal blood coagulation according to tests;not complicated by valvular heart disease,congenital heart disease and other heart diseases.For all the patients,their general clinical data was collected.The testing results for the fasting venous blood collected immediately they were hospitalized an d the fasting venous blood collected at 6h,12 h,24h and 48 h respectively foll owing the operation were unexceptionally collected,including blood routine,bl ood biochemistry,blood coagulation tests,etc.Blood tests were unexceptionally conducted with Sysmex XE-2100 automatic blood cell analyzer and auxiliary reagent as well as AU5800 fully automatic biochemical analyzer.Such preoper ative and postoperative biochemical indexes as SCr,CCr and eGFR of patients were observed;records were kept of the postoperative AKI occurrence rate,t he occurrence rate of postoperative poor wound healing,the occurrence rate of new postoperative ischemic encephalopathy,the postoperative renal failure that had to receive dialysis treatment,systemic inflammatory response markers(Creactive protein)quantification,the blood fat,cholesterol,hepatorenal function and tested electrolyte.Besides,comparisons were made of the patient head CT results obtained respectively before and after operation to find out if there wa s new postoperative ischemic encephalopathy.Graphpad prism was adopted to analyze intergroup biochemical indexes and the correlations;one-way anova wa s used to verify the data homoscedasticity;T tests and ?2tests were conducte d to analyze the obtained data and ascertain if there were intergroup correlatio ns.Moreover,logistic regression was applied to analyze the risk factors related to postoperative AKI.Results:A total of 894 patients were included in this research.After the operation,there was a statistically significant difference in serum creatinine(S Cr),estimated glomerular filtration rate(eGFR),and creatinine clearance rate(CCr)between the group combined with diabetes and the group without diabet es.Two groups of patients showed homogeneity of variance in their postoperative SCr values,so the author conducted the Tamhane's T2 test on them and c alculated that the F values were respectively 40.440,57.526,63.417 and 58.389,which was on the increase.All of the P values were less than 0.001,and t he highest F value and the smallest P value were detected after 24 hours(F =63.417),indicating that it was the time when differences between the groups were maximized.The SCr mean value was the highest after 12 hours and then on the decrease on the whole.Most of the patients' SCr values declined to p reoperative levels after 48 hours while some patients saw their CCr,SCr,and eGRF values even less than preoperative values after the coronary artery bypas s graft(CABG)surgery,suggesting that the variation within each group reache d the maximum degree at the time.The eGRF and CCr values in the two gro ups before and after the operation were tested by the Tamhane's T2,and the r esults showed that the F values were 6.921 and 54.724,and all of the P value s were less than 0.001,implying that patients' renal functions before and after surgery were also statistically different.In accordance with the relationship be tween the two groups' other complications calculated by the ?2 test,it was cl ear that the incidence of other complications between the two groups was also statistically different.The logistic regression analysis showed that the correlati on coefficient between diabetes and postoperative tested values was 2.07,and t he p-value was less than 0.01,which had some statistical significance.Conclusions:Compared to patients without DM,patients with DM were more prone to acute kidney injury(AKI)after OP-CABG,which appeared most at 12 h after surgery and had significant inter-group and intra-group difference in this time.Individual kidney showed a trend of deterioration or heal.In the two groups,the process of the AKI was not parallel to the process of systemic inflammatory response.The former healed at 48 h,while the latter continued to be aggravated.Diabetes has a positive correlation with the incidence of postoperative complications of coronary heart disease. |
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