糖尿病和非糖尿病急性心肌梗死的梗死区延伸的观察

A STUDY OF INFARCT EXTENSION DURING ACUTE MYOCARDIAL INFARCTIONIN PATIENTS WITH OR WITHOUT DIABETES MELLITUS

对本院近７年收入ＣＣＵ的３２０例心肌梗死（ＡＭＩ）患者进行了观察，按（１）ＣＫ－ＭＢ和（或）ＣＰＫ复升；（２）心电图ＳＴ段再次抬高及出现新的病理性Ｑ波或原有Ｑ波加深伴Ｒ波降低；（３）临床症状恶化等３项中２项作为梗死区延伸（ＩＥｘｔ）的临床诊断标准。糖尿病组５６例中共检出ＩＥｘｔ１７例（３０．３６％），无糖尿病组２６４例中检出ＩＥｘｔ２４例（９．１％），差异显著。糖尿病ＡＭＩ并发ＩＥｘｔ较多与其冠脉病变范围及严重程度发展有关，糖尿病的微血管病变、心肌对缺血的代谢调节障碍以及血小板聚集性、粘附性增高均与之有重要关系。

Infarct extension(IExt)is a severe complication in the early stage of acute myocardial infarction(AMI ) which is seldom reported in patients with diabetes mellitus. 320 cases of patients with AMI were admitted to CCU in the past 7 years , IExt was found in 17 cases among the 56 patients with diabetes(30. 36%), and IExt was found in 24 cases among the 264 patients without diabetes(9.1%).Diasnosic of IExt must meet two of the following criteria :(1) re-increasing of CK-MB and/or CPK;(2)reraising of S-T segment and new Q wave appearing,or Q wave deepening with decreasing of amplitude of Rwave;(3)worsening of clinical symptoms. The significant increase of IExt incidence in patients with diabetes is correlated with the extent of pathological changes in coronary arteries, microvascular pathological changes, disturbance of metabolism caused by ischemia in myocardium, and increase of platelet agre- gation and adhesiveness。