糖尿病并急性心肌梗死患者心脏超声和冠状动脉造影特点研究

The characteristic study of echocardiography and coronary angiography in diabetic patients with acute myocardial infarction

目的:了解糖尿病(DM)合并急性心肌梗死(AMI)患者心脏超声和冠状动脉病变的特征。方法:我科2001年7月至2004年12月收治的32例空腹血糖≥7.0mmol/L的AMI患者(DM组),同期选择与之性别、年龄(±3岁)、吸烟、高血压和心肌梗死部位相匹配的糖耐量正常的43例作为对照的AMI患者(NDM组),比较两组患者心脏超声结果和冠状动脉造影特点。结果:(1)空腹血糖和甘油三酯浓度DM组较NDM组高(p均<0.01);而高密度脂蛋白胆固醇DM组较NDM组低(p<0.01)。(2)DM组LA大于NDM组(p<0.01),DM组E峰、A峰和E/A均小于NDM组(p均<0.01)。(3)DM组较NDM组冠状动脉单支病变发生率低(p<0.05);而多支病变和弥漫性病变的发生率高(p<0.05);(4)无论DM组患者还是NDM组患者,三支病变的患者舒张功能最低。结论:(1)伴有DM的AMI患者冠状动脉病变范围广泛,DM患者发生AMI是多因素协同作用的结果;(2)伴有DM的AMI患者舒张功能明显异常。

Objective The characteristics of echocardiography and coronary angiography in diabetic patients with acute myocardial infarction was evaluated. MethodsDuring the same period, 32 patients with acute myocardial infarction（AMI） and fasting plasma glucose（FPG） ≥7.0mmol（ DM group） , 43 controls with AMI and normal FPG（ NDM group） were enrolled with on sex, age range（ ± 3 years） ,smoke cigarette,hypertension and position of myocardial infraction. The contrast analysis of the two groups was performed by echocardiographic results and coronary angiographic findings. Results （ 1 ） The levels of FPG and TG in DM group were markedly higher than that in NDM group（P 〈0.01） ,while the levels of HDL in DM group was markedly lower than that in NDM group（p 〈0.01 ）. （2） LA size in DM group was significantly higher than that in NDM group（p 〈 0.01 ） and E peak ,A peak and E/A in DM group were lower than that in NDM group（p 〈 0.01 ）. （ 3 ） Compared with NDM group, DM group had more extensively diffused coronary artery disease and was more likely to have triple vessel coronary artery disease （p 〈 0.05）. DM group patients with AMI were less likely to have single coronary artery pathological changes compared with NDM group（p 〈 0.05 ）. （4）The patients with three vessel coronary artery disease were the poorest left ventricular diastolic function among the patients in DM group or in NDM group. Conclusions The coronary artery pathological changes in patients with AMI and DM are extensive. AMI of DM comes from multi - factors conjunction ; compared to AMI patients with non - DM, the left ventricular diastolic function was much poor in AMI patients with DM ;the patients with three vessel coronary artery disease were the poorest left ventricular diastolic function.