急性心肌梗死伴2型糖尿病病人的临床分析  

Clinical Analysi s of Acute Myocardial Infarction patients with Non-insulin Dependent Diabetes Mellitus.

作　　者：吕蓓[1] 陆国平[1] 

机构地区：[1]上海第二医科大学附属瑞金医院心内科,200025

出　　处：《诊断学理论与实践》2002年第4期237-238,241,共3页Journal of Diagnostics Concepts & Practice

摘　　要：目的:分析急性心肌梗死(AMI)伴2型糖尿病(T2DM)病人的临床特点。方法:回顾性分析68例AMI伴T2DM病人和115例单纯AMI病人住院期间的临床资料和病死率。结果:AMI伴T2DM病人与单纯AMI病人相比,前壁AMI发生率较高(分别为42.6%和23.0%,P<0.01),左室射血分数较低(分别为37.7%±10.1%和52.5%±10.5%,P<0.01),冠状动脉病变较严重(多支病变:分别为51.5%和35.4%,P<0.01;弥漫病变:分别为23.5%和7.7%,P<0.01)。住院期间并发急性左心功能不全(Killip≥Ⅱ级:分别为35.3%和16.8%,P<0.01),严重心律失常(分别为33.8%和14.5%,P<0.01)和肺部感染(分别为26.5%和5.0%,P<0.01)发生率较高,住院期间病死率较高(分别为19.1%和9.7%,P<0.05)。预测死亡的独立危险因素有女性、Killip≥Ⅱ级、严重心律失常、肺部感染以及低分子肝素、血管紧张素转化酶抑制剂(ACEI)和他汀类治疗,且后三者与病人的病死率呈负相关。结论:AMI病人合并T2DM时,冠状动脉病变和临床病情较重,病死率高,因此冠心病病人应重视T2MD的防治。Objective:To observe the clinical characte ristics of acute myocardial infarction(AMI)patients with non-insulin dependent diabetes mellitus(NIDDM).Methods:Clinical data and mortality of68cases of AMI wi th NIDDM and155cases of simple AMI were retrospectively analyzed.Results:Compare d to the simple AMI patients,AMI patients with NIDDM had a higher incidence of a nterior AMI(42.6%vs.23.0%,P<0.01),lower LVEF(37.7%±10.1%vs.52.5%±10.5%,P< 0.01),more severe lesion of coronary atherosclerosis(multi-vessel lesion:51.5% vs.35.4%,P<0.01;extensive lesion:23.5%vs.7.7%,P<0.01).The AMI patients with MID DM had higer incidence of acute left ventricular insufficiency(Killip≥Ⅱ:35.3% vs.16.8%,P<0.01),severe cardiac arrhythmia(33.8%vs.14.8%,P<0.01),pulmonary infe ction(26.5%vs.5%,P<0.01),in-hospital mortality(19.1%vs.9.7%,P<0.05).The indepen dent predictors for death were female,Killip≥Ⅱ,severe cardiac arrhythmia,pulmo nary infection,low molecular weight heparin(LMWH),angiotensin-converting enzyme inhibitor(ACEI)and statins.The last three factors were negative correlated with the mortality of the AMI patients.Conclusions:Since the clinical condition and coronary lesion is severe and the mortality is high in AMI patients with NIDDM,t he prevention and treatment for NIDDM should be paid more attention.

关 键 词：急性心肌梗死 2型糖尿病 临床分析 冠心病 合并症 

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