糖尿病酮症酸中毒患者心肌酶谱与心电图变化分析  

The Changes of Myocardial Enzymogram and Electrocardiogram in Diabetic Ketoacidosis Patients

作　　者：刘海峰[1] 李玲文[2] 卢中秋[1] 田力[3] 

机构地区：[1]温州医学院附属第一医院急诊科,辽宁省沈阳市110004 [2]温州医学院附属第一医院心电图室浙,江省温州市325000 [3]中国医科大学盛京医院干诊科,辽宁省沈阳市110004

出　　处：《中国动脉硬化杂志》2007年第9期714-716,共3页Chinese Journal of Arteriosclerosis

摘　　要：目的通过观察糖尿病酮症酸中毒患者的心肌酶谱以及心电图改变,了解糖尿病酮症酸中毒对心肌的损害,进一步明确心肌酶谱以及心电图改变的意义。方法检测并比较44例糖尿病酮症酸中毒患者急性期以及缓解期的心肌酶谱,包括肌酸磷酸激酶、肌酸磷酸激酶同功酶、天门冬氨基转移酶以及肌钙蛋白Ⅰ;同时观察并比较患者的心电图变化。结果44例患者急性期的肌酸磷酸激酶、肌酸磷酸激酶同功酶以及天门冬氨基转移酶与缓解期比较明显升高,有统计学意义(P<0.05);急性期患者的肌酸磷酸激酶同功酶与肌酸磷酸激酶无相关性(r=0.12,P>0.05)。44例急性期患者心电图异常者28例(63.6%),主要异常是窦性心动过速18例(40.9%)以及ST-T改变14例(31.8%)。急性期心电图异常组患者的酸磷酸激酶、肌酸磷酸激酶同功酶以及天门冬氨基转移酶明显高于心电图正常组(P<0.05)。结论糖尿病酮症酸中毒患者心肌酶谱可以出现异常升高,糖尿病酮症酸中毒伴有心肌细胞的一过性非特异性损伤;糖尿病酮症酸中毒越重,患者越容易发生心律失常。Aim To observe the myecardium damage caused by diabetic ketoaeidosis with myocardial enzymogram and electrocardiogram and confirm their clinical significances. Methods 44 hospitalized patients had their vein blood drawn for determinating myocardial enzymogram which included creatine phosphokinase （CPK）, creatinine phosphokinase-MB （CPK-MB）, aspartate aminotransferases （AST） and cardiac troponin I （cTn-I） ; Meanwhile, the changes of electrocardiogram were recorded. The changes of myocardial enzymogram and electrocardiogram at acute stage were compared with these at catabafic stage. Results 44 patients with diabetic ketoacidosis had significantly higher levels of myocardial enzymogram at acute stage than those at catahafic stage （ P 〈 0.05）. CPK-MB and CPK values of 44 patients at acute stage had no correlation （ r = 0.12 , P 〉 0. 05）. 28（ 63.6%） patients with abnormal electrocardiogram changes at acute stage, and the major abnormities were 18 （40. 9%） sinus tachycardia, 14 （31.8%） ST-T change. The levels of myocardial enzyrmogram with abnormal electrocardiogram changes at acute stage were significantly higher than those with normal electrocardiogram changes （ P 〈 0.05 ）. Conclusions The levels of myocardial enzymogram caused by diabetic ketoacidosis might be abnormally higher. There was transient and nonspecial damage to myocardium. The occurence of ardlytlunia varied with the damage of diabetic ketoacidosis to myocardium.

关 键 词：内科学 糖尿病酮症酸中毒 心电图 肌酸磷酸激酶 肌酸磷酸激酶同功酶 天门冬氨基转移酶 肌钙蛋白Ⅰ 

分 类 号：R5[医药卫生—内科学]