心肌梗死前心绞痛对合并糖尿病急性前壁心肌梗死患者左心室舒张功能的影响  

Effects of prodromal angina pectoris on left ventricular diastolic function of in diabetic patients with acute anterior myocardial infarction

作　　者：马彩云[1] 任凤学[1] 孙健玲[1] 刘芳[1] 李瑞杰 任文林[3] 杜凤和[4] 

机构地区：[1]航空工业中心医院心内科,北京100012 [2]北京市朝阳第二医院心内科,北京100026 [3]北京市垂杨柳医院心内科,北京100022 [4]首都医科大学附属北京天坛医院心内科,北京100022

出　　处：《临床荟萃》2010年第20期1776-1778,共3页Clinical Focus

摘　　要：目的探讨心肌梗死前心绞痛对合并糖尿病的急性前壁心肌梗死患者左心室舒张功能的影响。方法行急诊冠状动脉造影示梗死相关动脉为前降支近中段病变并成功进行经皮冠状动脉介入治疗(PCI)的首次急性前壁心肌梗死患者114例,其中63例合并有糖尿病,共分为4组;非糖尿病心肌梗死前有心绞痛组23例(A组);非糖尿病心肌梗死前无心绞痛组28例(B组);糖尿病心肌梗死前有心绞痛组28例(C组);糖尿病心肌梗死前无心绞痛组35例(D组)。比较心肌梗各组死前心绞痛对肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)峰值浓度和左心室舒张功能的影响。结果 CK、CK-MB的峰值浓度A组显著低于B组,CK(1 696±1 062)U/L vs(2 988±1 632)U/L,CK-MB(125±83)U/L vs(236±159)U/L(P<0.05或<0.01),二尖瓣口舒张早期血流峰值流速(PE)/舒张晚期血流峰值流速(PA):A组显著高于B组和C组,1.07±0.38 vs 0.87±0.26、0.78±0.23(P<0.05或<0.01),而C组与D组之间这些指标差异均无统计学意义(P>0.05)。结论心肌梗死前心绞痛不能改善合并糖尿病急性前壁心肌梗死患者的左心室舒张功能。Objective To investigate the short-term effects of prodromal angina pectoris on left diastolic ventricular function and infarct size in diabetic patients with acute anterior myocardial infarction（AMI）.Methods 114 patients with first acute anterior myocardial infarction of the proximal left anterior descending artery who underwent successful direct percutaneous coronary intervention（PCI）：51 cases without diabetes were divided into group A（with prodromal AP） and group B（without prodromal AP）.Another 63 cases with diabetes were divided into group C（with prodromal AP） and group D（without prodromal AP）.The effects of prodromal AP on peak creatine kinase（CK） value and left ventricular diastolic function were analyzed respectively.Results The peak CK,CK-MB were significantly lower in group A than those in group B,CK（1 696±1 062） U/L vs（2 988±1 632） U/L,CK-MB（125±83） U/L vs（236±159） U/L（P〈0.05 or〈 0.01）,at the time,the ratio of the early peak velocity /the late peak velocity in diastole of mitral flow（E/A） was significantly higher in group A than that in group B and in group C,1.07±0.38 vs 0.87±0.26 and 0.78±0.23（P〈0.05 or 0.01）,while there were no significant differences in various items between group C and group D（all P〉0.05）.Conclusion Prodromal angina pectoris limits infarct size,protects the left ventricular diastolic function in non-diabetic patients with AMI.However,such beneficial effects of prodromal angina pectoris were not observed in diabetic patients,suggesting that diabetes might prevent ischemic preconditioning.

关 键 词：心肌梗死 心绞痛 缺血预适应 糖尿病 

分 类 号：R541.42[医药卫生—心血管疾病]