糖尿病合并急性心肌梗塞患者的临床特点及长期预后

CLINICAL CHARACTERISTICS AND LONG-TERM PROGNOSIS OF ACUTE MYOCARDIAL INFARCTION IN DIABETIC PATIENTS

为了解糖尿病和非糖尿病急性心肌梗塞（ＡＭＩ）患者住院期间病情、预后以及长期生存率的差异，本文选择１９８６年１月至１９９２年９月间住院糖尿病ＡＭＩ患者１０３例（Ａ组），并从同期４８１例住院非糖尿病ＡＭＩ患者中随机选择１１９例（Ｂ组）。分别随访４．１２±２．０６年（Ａ组）及３．９７±１．７９年（Ｂ组）。结果表明，糖尿病患者ＡＭＩ发病年龄低，严重心力衰揭发生率高，病情多较重，因而住院时间也较对照组明显延长。糖尿病患者合并ＡＭＩ病死率高，女性患者更为明显。其病死率还与ＡＭＩ发病前血糖控制程度有关。随访发现，糖尿病患者再梗塞及病死率较非糖尿病患者明显增高，而长期存活率降低。

One hundred and three AMI patients with diabetes (Group A) and 119 patients (Group B) selected randomly from 481 nondiabetic AMI patients were included in this study from Jan. 1986 to Sept.1992. The patients survived from acute phase of AMI were followed up for 4.12±2.06 and 3.97±1.79 years in Group A and B, respectively. Results: ①Compared with Group B,the average age in Group A was lower (p<0.001) , and the average period staying in hospital longer(p<0.001). ②In Group A, 25. 2% patients without typical chest pain, compared with 12.6% patients in Group B (p<0.05). The incidence of congestive heart failure (CHF) was 41.7% and 33.6% in Group A and B, respectively. whereas the incidence of severe CHF was significantly higher in Group A(p<0.05). There were no differences between two groups in the incidence of other complications, such as severe arrhythmia, cardiogenic shock and infection.The hospital mortality was 30. 1% and 13.4% in Group A and B, respectively (p<0.01).In Group A,the mortality rate in female was 46.3%, compared with only 19.4% in male of the same group(p<0.01); whereas inGroup B, the mortality rate was the same in both sexes.③In the diabetics with blood sugar well controlled before admission,the hospital mortality rate was 12.5% (same as in Group B),compared with 34.3% in patients with prehospital blood sugar uncontrolled (p<0.05). ④93.2% and 94.1% of the survival patients were followed up in Group A and B, respectively. The cumulated survival rate during the following up period was lower in Group A than in Group B, 39.0%and 73.4% (p<0.001),respectively.The occurrence of reinfarction in Group A was higher than that in Group B (p<0.01). In the diabetics with blood sugar well controlled before admission, the long term mortality and reinfarction rate were significantly lower than those with prehospital blood sugar uncontrolled (p<0.02).In patients complicated by CHF in the hospital or LVEF<50% at discharge, the long term motality were significantly higher (p<0.05).