心肌梗死合并糖尿病的患者心室重构和血浆内分泌激素水平的临床研究

Clinical study on ventricular remodelling and the plasma concentrations of neurohomones in patients with myocardial infarction accompanied by diabetes mellitus

目的 探讨在拮抗神经内分泌激素治疗下 ,心肌梗死合并糖尿病的患者心室重构和血浆内分泌激素水平变化特点。方法 本研究收集急性心肌梗死合并糖尿病的患者 4 5例为糖尿病组 ,同时随机入选 4 5例无糖尿病的急性心肌梗死患者作为对照组。给予相同的倍他受体阻滞剂 +血管紧张素转换酶抑制剂联合治疗 ,比较两组患者在用药前后心室重构的逆转以及血浆内分泌激素水平和心脏功能变化 ,并比较两组间心室重构的逆转以及血浆内分泌激素水平变化的差别。结果 糖尿病组患者左室收缩末期内径、左心室射血分数、肾素和血管紧张素Ⅱ与治疗前比较差异有显著性意义 (P <0 .0 5 ) ,对照组患者左室收缩末内径、左室收缩末容积、左心室射血分数、肾素和血管紧张素Ⅱ与治疗前比较差异有显著性意义 (P <0 .0 1) ,醛固酮与治疗前比较有统计学意义 (P <0 .0 5 )。结论 拮抗神经内分泌激素治疗对于心肌梗死合并糖尿病患者在逆转心室重构、改善心脏功能及降低血浆内分泌激素水平方面与非糖尿病心肌梗死患者比较疗效较差 ,但对于逆转心室重构及改善心脏功能仍有肯定的临床效果。

Objective To explore the characteristics of ventricular remodelling and the plasma concentrations of neurohomones in patients with acute myocardial infarction accompanied by diabetes mellitus.Methods Forty-five patients with acute myocardial infarction accompanied by diabetes mellitus who were in-petients in our hospital were chosen as diabetes group and 45 acute myocardial infarction patients without diabetes mellitus were chosen at random as control group.All patients were given beta-receptor blocking agent and angiotensin-converting enzyme inhibitor and then were followed up for 6 months.Ventricular remodelling and the plasma concentrations of neurohomones were compared before and after anti-neurohomone drugs were given and at the same time,difference in ventricular remodelling and the plasma concentrations of neurohomones between the two groups were compared.Results LVESD,LVEF,PRA and AngⅡ in diabetes mellitus group were statistically different(P< 0.05)before and after the drugs were used. LVESD,LVESV,LVEF,PRA and AngⅡ in control group were also statistically significantly different (P<0.01)before and after the drugs were used.Ald-osterone was different after treatment as compared with before treatment(P<0.05).Conclusion Diabetes mellitus group was not better than non-diabetes mellitus group in improvement of ventricular remodelling and heart function and reducing the plasma concentrations of neurohomones after treatment,but there was affirmative effectiveness in improvement of ventricular remodelling and heart function.