静脉溶栓治疗对糖尿病并发急性心肌梗死患者近远期效果的影响  

Influence of a History of Diabetes on Thrombolytic Therapy:Short and Long-Term Outcome

作　　者：赵兴山[1] 范丽雯[1] 张源 彭璐[1] 高秉新[1] 张家利[1] 康健[1] 

机构地区：[1]北京大学第四临床医学院 北京积水潭医院 心内科,北京市100035

出　　处：《中国循环杂志》2007年第2期96-99,共4页Chinese Circulation Journal

摘　　要：目的:本研究探讨静脉溶栓治疗对糖尿病并发急性心肌梗死(AMI)患者近远期效果的影响。方法:对本院连续住院治疗的116例AMI的溶栓治疗患者,按临床诊断分成糖尿病组(n=26)、非糖尿病组(n= 90)。根据胸痛症状、心电图ST段抬高和下降情况及心肌酶水平峰值变化,采用中华医学会心血病学分会制定的间接标准及其组合判断方法评定梗塞相关血管是否再通,随访观察和分析2组治疗效果。结果:开始溶栓时间:糖尿病组平均为(5.69±2.24)h,非糖尿病组平均为(4.68±1.80)h,两组比较糖尿病组时间延长,有显著性差异(P<0.05)。梗塞血管再通:糖尿病组有13例,再通率为56.5%,非糖尿病组66例,再通率为75.9%,两组再通率相比,糖尿病组明显低于非糖尿病组,有显著性差异(P<0.025)。心力衰竭发生率在糖尿病组溶栓后有42.3% (11例),非糖尿病组21.1%(19例),两组发生率比较糖尿病组严重心力衰竭的发生率高于非糖尿病组,有显著性差异(P<0.05)。住院病死率在糖尿病组死亡5例(占19.2%),非糖尿病组死亡9例(占10.0%),两组相比,糖尿病组死亡率有增多趋势,但尚无显著性差异(P>0.05)。平均随访5.6年(2.2～7.5年),糖尿病组病死率高于非糖尿病组(P<0.05)。结论:糖尿病并发急性心肌梗死患者经溶栓治疗后,仍有较差的近期及远期预后,其溶栓治疗再通率较低,与糖尿病患者开始溶栓时间延迟有关。Objective： The aim of this study was to investigate the influence of diabetes on intravenous thrombolytic therapy in patients with acute myocardial infarction （AMI）. Methods ： The study included 116 consecutively admitted patients with AMI ,and 26 （22.4%） of them had diabetes mellitus （DM）. All patients were treated with intravenous thrombolytic therapy. Results： There were more female patients in DM-AMI group （38.4.6% vs 17.78 %, P 〈 0, 05 ）. Time to thrombolysis in DM-AMI group was significantly delayed （5.69 ±2. 24. vs 4.68 ± 1.80 hrs,P 〈0. 05 ）. The reprefusion rate of infarct-related artery was lower than NDM-AMI group （56. 5% vs 75.9%, P 〈 0. 025 ）. Serum creatine phosphokinase and creatine kinase MB isoenzyme had no significant difference between two groups （ P 〉 0.05 ）. The rate of cardiac failure more than Killips grade Ⅲ was 42. 3% in DM-AMI group and 21.2% in NDM-AMI group （P 〈 0.05 ）. In-hospital mortality was increased in DM-AMI group, but had no statistical significance compared with the NDM-AMI group （ 19.2% vs 10% ,P 〉0. 05）. The long-term 5.6 year mor- tality following AMI was significantly increased in DM-AMI group （34. 6% vs 15.6% ,P 〈 0. 05）. Conclusions ： This study showed that the prognosis of thrombolytic therapy in diabetic patients complicated by acute myocardial infarction is still worse, though the patients received with thrombolysis. The lower repatency rate of diabetic patients is associated with the delay to thrombolytic therapy.

关 键 词：糖尿病 心肌梗塞 溶栓治疗 

分 类 号：R541.4[医药卫生—心血管疾病]