急性心肌梗死合并糖尿病患者冠脉介入治疗后心室重构的变化  

Changes of ventricular remodeling in patients with acute myocardial infarction combined with diabetes mellitus after PCI

作　　者：李亚芹[1] 王乾一[1] 徐占稳[1] 康世鑫[1] 魏媛[1] 李靖[1] LI Yaqin WANG Qianyi XU Zhanwen KANG Shixin WEI Yuan Ll jing(Affiliated Hospital of Hebei University, Baoding 071000, China)

机构地区：[1]河北大学附属医院,河北保定071000

出　　处：《山东医药》2017年第1期19-21,共3页Shandong Medical Journal

基　　金：河北省科技厅科技支撑计划资助项目(14277786D)

摘　　要：目的探讨糖尿病对急性心肌梗死患者冠脉介入治疗后心室重构的影响。方法选择急性ST段抬高型心肌梗死并行冠脉介入治疗患者115例,其中合并糖尿病37例(糖尿病组)。无糖尿病78例(非糖尿病组)。采用酶联免疫吸附法检测两组血清CPK、CK-MB、TC、HDL-C、LDL-C、TG、FPG、GHb A1c水平,采用心脏超声测定两组左室舒张末期容量(LVEDV)及左室收缩末期容量(LVESV)、左室射血分数(LVEF)、E/A、心脏等容舒张时间(IVRT)、室壁运动指数(WMSI);观察两组左室重构、心力衰竭、心电图ST段回落>70%发生率。结果随访6个月,糖尿病组失访1例,死亡1例,非糖尿病组失访4例,死亡1例;余108例完成整个随访过程。PCI治疗6个月,两组血清CPK、CK-MB、TC、HDL-C、LDL-C、TG水平差异无统计学意义(P均>0.05),FPG、GHb A1c差异有统计学意义(P均<0.05);两组LVEDV、LVEF、E/A、IVRT差异无统计学意义(P均>0.05),LVESV、WMSI差异有统计学意义(P均<0.05)。糖尿病组心电图相应导联ST段回落>70%的发生率低于非糖尿病组(17.14%vs 47.94%,P=0.003);有心力衰竭症状的患者糖尿病组比非糖尿病组多(37.14%vs 19.17%,P=0.008);行PCI治疗后心室重构的发生率糖尿病组与非糖尿病相比无统计学差异(37.14%vs 28.76%,P=0.082)。结论急性心肌梗死合并糖尿病患者PCI术后出现心力衰竭的概率比无糖尿病患者高,但与心室重构无直接关系。Objective To investigate the influence of diabetes mellitus （DM）on ventricular remodeling in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention （PCI）.Methods Totally 115 pa-tients with acute ST-segment elevation cardial infarction （STEMI）underwent PCI,including 37 cases of patients with DM （AMI with DM,DMgroup）and 78 cases without DM（AMI without DM,non-DMgroup）.The levels of CPK,CK-MB, TC,HDL-C,LDL-C,TG,FPG,and HbAc1 were detected by ELASA.The left ventricular end-diastolic volume （LV-EDV）,left ventricular end-systolic volume （LVESV）,left ventricular ejection fraction （LVEF）,E /A,heart isovolumic relaxation time （IVRT）,and wall motion score index （WMSI）was determined by echocardiography in the two groups.The left ventricular remodeling and heart failure,and the incidence rate of ST-segment fall 〉70% was observed in the two groups.Results All patients were followed up for 6 months.In the DMgroup,1 lost to follow-up,1 died,while in the non-DMgroup,4 lost to follow-up,and 1 died.The rest of 108 patients completed follow-up process.After 6-month PCI, no statistical difference was found in CK,CK-MB,TC,HDL-C,LDL-C,and TG between these two groups （all P 〉0.05）,while significant difference was found in FPG and HbA1c between these two groups （all P 〈0.05）.No statistical difference was found in LVEDV,LVEF,E /A and IVRT between these two groups （all P 〉0.05）.LVESV,WMSI had statitical difference （all P 〈0.05）.Patients with DMshowed a significantly higher rate of ST-segment fall 〉70% as com-pared with that of patients without DM（17.14% vs 47.94%,P =0.003）.Despite a similar incidence of LV remodeling＆nbsp;between DMand non-DMgroups （37.14% vs 28.76%,P =0.082）,symptoms of heart failure were significantly more in diabetic patients （37.14% vs 19.17%,P =0.008）at 6-month follow-up.Conclusion The risk of heart failure after PCI in patients with acute myocardial infarction and diabetes mellitus is higher than

关 键 词：急性心肌梗死 冠脉介入治疗 心室重构 糖尿病 

分 类 号：R542.2[医药卫生—心血管疾病]