糖尿病酮症对中青年患者心脏的影响  

The adverse effects of diabetic ketosis on heart in young and middie-aged patients

作　　者：张秋梅[1] 于德民[1] 李金金[1] 李晶[1] 李春君[1] 

机构地区：[1]天津医科大学代谢病医院内分泌科卫生部激素与发育重点实验室天津市激素与发育重点实验室,300070

出　　处：《中国医药》2010年第4期325-327,共3页China Medicine

摘　　要：目的通过观察中青年糖尿病酮症患者心肌酶谱以及心电图改变，探讨糖尿病酮症对心脏的损害。方法入选78例中青年2型糖尿病酮症患者，急性期及酮症纠正后检测肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）及天门冬氨基转移酶（AST）；同时观察并比较患者心电图的变化。结果78例酮症期患者血清肌酸激酶、CK-MB及AST水平与缓解期比较均明显升高；78例急性期患者心电图异常者46例（58．9％），主要异常是ST-T改变32例（41．0％），其中ST段压低8例，ST段抬高1例，T波平坦或倒置23例，窦性心动过速18例（23．1％），缓解期有32例心电图异常的患者好转，其中20例恢复正常；急性期心电图异常患者组血清肌酸激酶、CK—MB及AST水平明显高于心电图正常组（P〈0．05）；78例患者中有3例酮症患者急性期肌酸激酶、CK—MB及AST超过正常值2倍，2例患者ST段压低0．1mV，1例患者ST段轻度抬高，缓解期肌酸激酶、CK-MB及AST恢复正常，3例心电图均有明显改善，2例ST段压低患者升高0．05mV以上，ST段抬高者恢复到基线水平。结论糖尿病酮症患者存在心脏-过性非特异性损害，心肌酶谱可以出现异常升高，酮症期间应重视心脏的监测，酮体纠正后应重视心脏的随访与评价。Objective To observe the changes of myocardial enzymogram and myocardial damage during diabetic ketosis （DK）or diabetic ketoacidosis（DKA） in young and middle-aged patients. Methods Seventy-eight hospitalized patients （45 male and 33 female） of DKA were recruited. Myocardial enzymogram which included creatine phosphokinase （ CK）, creatine phosphokinase isoenzyme （ CK-MB ） and aspart aminotransferases （AST） was measured on admission at ketosis stage and on 7 days after ketosis recovery. Electrocardiographs were also performed and compared during those two stages. Results Seventy-eight hospitalized patients with DK or DKA had significandy higher levels of myocardial enzymogramCK, CK-MB and AST at ketosis stage than those in stable stage. The changes of ECG were found in 46 cases （58.9%） of all the patients. The highest morbidity of ECG abnormality was ST-T change which was found in 32 cases（41.0% ） , ST segment depression in 8 cases, ST segment height in 1 case, T wave flat or inversion in 23 cases, sinus tachycardia in 18 cases （23.1%）. 32 of 46 cases with abnormal ECG improved on 7th day with ketosis recovery, furthermore,20 cases fully recovered. The levels of CK, CK-MB and AST with abnormal ECG in acute stage were significantly higher than those with normal ECG. 3 patients had severe ketoacidosis, minute elevations of myocardial biomarkers showed 2 folds above reference value. ST segment showed depression of 0.1 mV in 2 cases and ST segment elevated in 1 case. The high levels of CK, CK-Mb and AST and changes of ECG restored in the stable stage. T segment restored 0. 05 mV in 2 patient with ST segment depression and ST segment elevation in 1 case restored to normal also. Conclusions Diabetic ketoacidosis has a nonspecific myocardial injury. The myocardial changes should be monitored and effective protective therapy should be taken during ketosis episode.

关 键 词：糖尿病酮症 心肌酶 心电图 

分 类 号：R587[医药卫生—内分泌]