糖耐量减低对老年急性心肌梗死患者心室重构的影响及阿卡波糖的干预效果  

Influence of impaired glucose tolerance on ventricular remodeling in elder patients with acute myocardial infarction and the interventional effect of acarbose

作　　者：张韩[1] 刘枫[2] 万琪琳[1] 姚新亮[1] 钟小鸣[1] 王治中[1] 闫成芸 

机构地区：[1]河南大学淮河医院心血管内科,河南开封475000 [2]河南大学淮河医院重症医学科,河南开封475000

出　　处：《中华实用诊断与治疗杂志》2015年第6期615-616,619,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省卫生厅医学科技攻关计划项目(200903105)

摘　　要：目的探讨糖耐量减低对老年急性心肌梗死患者心室重构的影响及应用阿卡波糖治疗的效果。方法年龄≥60岁心肌梗死患者240例,其中血糖正常者80例(血糖正常组),糖耐量异常者160例(糖耐量减低组),再将糖耐量减低者随机分为干预组和未干预组各80例。3组均给予急性心肌梗死正规治疗,干预组并给予阿卡波糖口服。分别于治疗前及治疗后1、6、12个月测定3组左心室舒张末期内径(left ventricular end-diastolic dimonsion,LVEDD)、左心房前后内径(left atrial diameter,LAD)、左室射血分数(left ventricular ejection fraction,LVEF),并进行比较。结果血糖正常组治疗前LVEDD[(43.08±1.21)mm]和LAD[(32.19±1.11)mm]低于干预组[LVEDD(48.08±1.23)mm,LAD(35.03±1.14)mm]和未干预组[LVEDD(47.03±1.31)mm,LAD(35.14±1.22)mm],LVEF[(54.21±4.42)%]高于干预组[(51.18±4.23)%]和未干预组[(50.03±4.63)%](P<0.05);治疗12个月后未干预组LVEDD[(57.14±1.58)mm]、LAD[(38.11±1.25)mm]高于干预组[LVEDD(53.53±1.49)mm,LAD(36.13±1.51)mm]和血糖正常组[LVEDD(52.19±1.51)mm,LAD(36.14±1.41)mm],LVEF[(43.99±5.22)%]低于干预组[(53.41±4.54)%]和血糖正常组[(54.11±4.11)%](P<0.05);干预组与血糖正常组比较差异无统计学意义(P>0.05)。结论糖耐量减低对心肌梗死后心室重构起促进作用,阿卡波糖可减轻糖耐量减低患者急性心肌梗死后心室重构。Objective To explore the influence of impaired glucose tolerance（IGT）on myocardial remodeling in elder patients with acute myocardial infarction（AMI）and the interventional effect of acarbose.Methods A total of 240 AMI patients aged 60 years or older included 80 patients with normal plasma glucose（normal glucose group）and 160 patients with IGT which were randomly divided into interventional group and non-interventional group,with 80 patients in each group.Besides the regular therapy for AMI in the other two groups,interventional group received oral administration of acarbose.All three groups were measured left ventricular end-diastolic dimension（LVEDD）,left atrial diameter（LAD）and left ventricular ejection fraction（LVEF）by Doppler echocardiography before and after 1-,6-and 12-month treatment and compared among three groups.Results LVEDD（（43.08±1.21）mm）and LAD（（32.19±1.11）mm）were lower and LVEF（（54.21±4.42）%）was higher in normal glucose group than those in interventional group（（48.08±1.23）mm,（35.03±1.14）mm,（51.18±4.23）%）and non-interventional group（（47.03±1.31）mm,（35.14±1.22）mm,（50.03±4.63）%）before treatment（p〈0.05）.LVEDD（（57.14±1.58）mm）and LAD（（38.11±1.25）mm）were higher and LVEF（（43.99±5.22）%）was lower in non-interventional group than those in interventional group（（53.53±1.49）mm,（36.13±1.51）mm,（53.41±4.54）%）and normal glucose group（52.19±1.51）mm,（36.14±1.41）mm,（54.11±4.11）%）after 12-month treatment（p〈0.05）.ConclusionIGT aggravates ventricular remodeling after AMI,which can be reduced significantly by acarbose.

关 键 词：急性心肌梗死 糖耐量减低 心室重构 阿卡波糖 

分 类 号：R587.1[医药卫生—内分泌]