糖尿病合并急性心肌梗死患者左室舒张功能与缺血预适应的关系

Correlation between ischemic preconditioning and left ventricular diastolic function in diabetic patients with acute myocardial infarction

目的:探讨糖尿病合并急性心肌梗死(AMI)患者左室舒张功能与缺血预适应的关系。方法:选择188例首次AMI患者分为4组:A组,非糖尿病缺血预适应组(37例);B组,非糖尿病无缺血预适应组(44例);C组,糖尿病缺血预适应组(51例);D组,糖尿病无缺血预适应组(56例)。比较缺血预适应对肌酸激酶(CK)峰值浓度和左室舒张功能的影响。结果:A组的CK、CK-MB峰值浓度和二尖瓣口舒张早期血流峰值流速/舒张晚期血流峰值流速比值(E/A比值)<1的发生率均显著低于其他各组(P<0.01),而E/A比值显著高于其他各组(P<0.05,P<0.01),其余各组间这些指标均无显著性差异。结论:缺血预适应对无糖尿病的AMI患者能够限制梗死面积,保护左室舒张功能;而对合并糖尿病的AMI患者,这种心脏保护作用不明显。

Objective: To investigate the short-term effects of ischemic preconditioning (IP) on left ventricular diastolic function in diabetic patients with acute myocardial infarction(AMI). Methods: Totally 188 patients with first AMI were studied. Eighty-one patients without diabetes were divided into group A (with IP) and group B (without IP). The other 107 patients with diabetes were divided into group C (with IP) and group D (without IP).The effect of IP on peak creatine kinase value and left ventricular diastolic function were analyzed separately. Results: The peak creatine kinase value, the peak creatine kinase MB fractions and the incidence of E/A<1 (E/A: Gicuspid peak velocities during early diastole/during late diastole) were significantly lower in group A than those in the other groups (P<0.01).At the same time, E/A was significantly higher in group A than that in the other groups (P<0.05 or P<0.01), while there was no significant difference between E/A in the other groups. Conclusion: Ischemic preconditioning can limit infarct size and protect the left ventricular diastolic function in non-diabetic AMI patients. However, such beneficial effects of ischemic preconditioning are not observed in diabetic AMI patients.