糖尿病对未发生过心肌梗死的老年冠心病患者存活心肌的影响  

Impact of diabetes on viable myocardium in elderly coronary heart disease patients without myocardial infarction

作　　者：刘虹宏 张冬花[1] 杨永红[1] 高云[1] 王茜[1] 林运[1] Liu Honghong;Zhang Donghua;Yang Yonghong;Gao Yun;Wang Qian;Lin Yun(Department of Cardiology,Beijing Anzhen Hos pital,Ca pital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心内科,100029

出　　处：《中华老年心脑血管病杂志》2023年第10期1042-1045,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：首都卫生发展科研专项(2022-2G-1055)。

摘　　要：目的探讨糖尿病对未发生过心肌梗死的老年冠心病患者存活心肌的影响。方法选取2019年6月至2022年9月首都医科大学附属北京安贞医院心内科就诊的未发生过心肌梗死的老年冠心病患者122例,根据是否有存活心肌分为存活心肌组68例和无存活心肌组54例,又依据是否有糖尿病史分为糖尿病组72例和非糖尿病组50例。所有患者接受静息及运动负荷心肌灌注单光子发射计算机断层摄影及18F-氟代脱氧葡萄糖正电子发射断层显像,分析存活心肌情况和影响因素。结果存活心肌组糖尿病及肥胖比例明显低于无存活心肌组(33.8%vs90.7%,P<0.01;17.6%vs38.9%,P<0.01)。糖尿病组缺少身体活动、高血压、肥胖比例明显高于非糖尿病组(P<0.05,P<0.01),缺血心肌区域前壁、下壁、侧壁、间壁存活心肌比例明显低于非糖尿病组,差异有统计学意义(P<0.01)。单因素logistic回归分析显示,糖尿病是导致缺血心肌区域无存活心肌比例升高的危险因素(95%CI:6.721~54.703,P=0.001)。多因素logistic回归分析显示,调整性别、年龄以及进一步调整肥胖的影响后,糖尿病相对危险度为24.564(95%CI:7.464~80.865,P=0.001)。结论糖尿病患者缺血心肌区域存活心肌比例更少,建议未发生过心肌梗死的冠心病患者,特别是合并糖尿病患者应积极评估缺血区域的存活心肌。Objective To investigate the impact of diabetes on the surviving myocardium in elderly patients with coronary heart disease(CHD)but without myocardial infarction.Methods A total of 122 elderly patients admitted to our hospital from June 2019 to September 2022 and had been diagnosed with CHD but had not haven myocardial infarction were enrolled,and then divided into surviving myocardium group(68 cases)and non-surviving myocardium group(54 cases),and also divided into diabetic group(72 cases)and non-diabetic group(50 cases).Resting and exercise load myocardial perfusion single photon emission computed tomography and 18 F-FDG myocardial posi-tron emission computed tomography were performed on all the patients to analyze the surviving myocardium and the influencing factors.Results The surviving myocardium group had signifi-cantly lower proportions of diabetes and obesity than the non-surviving myocardium group(33.8%Us 90.7%,P<0.01;17.6%Us 38.9%,P<0.01).The diabetic group presented obviously larger proportions of absence of activity,hypertension and obesity(P<0.05,P<0.01),while low-er ratios of viable myocardium in the anterior,inferior,lateral,and septal walls in each ischemia area(P<0.01)when compared with the non-diabetic patients.Single factor logistic regression analysis showed that diabetes was a risk factor for increasing ratio of non-surviving myocardium in ischemic myocardial area(95%CI:6.721-54.703,P=0.001).Multifactor logistic regression analysis indicated that after adjusting for age and sex,and further adjusting for obesity,the relative risk of diabetes was 24.564(95%CI:7.464-80.865,P=0.001).Conclusion Diabetes signifi-cantly reduces the amount of viable myocardium in the elderly CHD patients.It is recommended that for the CHD patients without myocardial infarction,especially those complicated with diabe-tes,evaluation for viable myocardium in ischemic area is essential.

关 键 词：冠心病 心肌梗死 糖尿病 正电子发射断层显像术 

分 类 号：R542.22[医药卫生—心血管疾病] R587.2[医药卫生—内科学]