ST段抬高急性心肌梗死合并2型糖尿病患者PCI前后CTFC和TMPG的变化

Changes of CTFC and TMPG after PCI in patients with ST segment elevation acute myocardial infarction complicated with types 2 diabetes mellitus

目的探讨ST段抬高的急性心肌梗死(STEMI)合并2型糖尿病(DM)患者经皮冠状动脉介入治疗(PCI)前后校正的心肌梗死溶栓治疗临床实验(TIMI)帧数(CTFC)及TIMI心肌灌注分级(TMPG)的变化以及对其预后的影响。方法回顾性分析行PCI的STEMI患者97例,其中STEMI合并DM组34例(DM组),单纯STEMI组63例(对照组),测定2组梗死相关动脉(IRA)的TIMI、CTFC和TMPG,并分析两组住院期间和PCI治疗6个月后的主要心脏不良事件(MACE)的发生率。结果与对照组比较,DM组的年龄、体重指数、既往心梗史、多支血管病变和高血压发生率均明显升高(P<0.05),肌酸激酶(CPK)显著增加(P<0.05),前降支病变明显增多(P=0.01),CTFC明显增加(P<0.001),TMPG明显减少(P=0.008),左室射血分数(LVEF)显著降低(P<0.01)。住院期间2组MACE发生率无显著差异,6个月随访期间DM组较对照组明显增加(P<0.05)。结论STEMI合并2型DM患者行PCI治疗后的心肌再灌注明显改善,但与无DM的STEMI患者相比心肌灌注减少,梗死范围大,心功能降低,远期预后差。

Objective To explore the changes of TIMI frame count （CTFC） and TIMI myocardial perfusion grade （TMPG） before and after percutaneous coronary intervention（PCI） in S-T segment elevation acute myocardial infarction（STEMI） patients with type 2 diabetes mellitus（DM） and their impacts on prognosis. Methods Ninty-seven STEMI patients performend with PCI were analyzed retrospectively, including 34 patients with STEMI complicated with DM（DM group）and 63 patients with STEMI （control group）. TIMI,CTFC and TMPG of infarction related artery（IRA） were detected . Incidence of major adverse cardiac events（MACE） in the course of hospitalization and six months late in two groups was analyzed. Results Compared with control group, DM group were older（62.1±9.2 years vs 58.4±10.3 years, P=0. 004）, had higher body mass index （29±5 vs 27±3, P = 0. 002）, more frequent history of myocardial infarction and higher prevalence of hypertension（P = 0. 002）, higher levels of CPK （3238 ±1018 vs 2365±1032, P 〈 0.05 ）, lessen left anterior descending lesion（59. 7% vs 42.3%, P=0.01）,and CFFC increased （35±27 vs 21 ±12, P〈0.0001）.TMPG decreased obviously（24.5% and 43.6 %, P = 0. 008）, left ventricular ejection fraction （LVEF） decreased obviously （0.39±0.11 和0.64±0.12, P 〈 0.01 ）. The incidence of MACE during hospitalization was no obviouse difference in two groups, during six-month follow-up period was significantly higher in DM group than that in control group DM （P 〈 0.05）. Conclusion In the STEMI patients with type 2 DM, myocardial reperfusion is obviously improved after PCI, but the area of myocardial infarction is larger, myocardial reperfusion is decreased and the heart function is relatively poor and prospective prognosis is poor compared with STEMI patients without DM.