长期抗神经内分泌治疗对高血糖心肌梗死患者左心室功能的影响

Effects of long-term anti-nuroendocrine treatment on left ventriclar function of patients with myocardial infarction accompanied by hyperglycemia

目的观察长期抗神经内分泌治疗对高血糖心肌梗死患者神经内分泌激素及左心室功能的影响。方法将入选的65例心肌梗死患者,分为血糖正常组(34例)和高血糖组(31例),给予美托洛尔加血管紧张素转换酶抑制剂(ACEI)治疗,分别于治疗前和治疗后6个月采血检测血浆神经内分泌激素的水平。随访2年分别于治疗前和治疗后行超声心动图检测,观察两组患者在用药前后心室重构的逆转、左心室功能的变化。结果使用美托洛尔并ACEI可以降低血糖正常组和高血糖组患者的血浆肾素、血管紧张素Ⅱ水平,血浆肾素活性、血管紧张素Ⅱ浓度降低,差异有显著性意义(P<0.05)。血糖正常组患者治疗后左心室射血分数(LVEF)好转(P<0.05),高血糖组患者LVEF虽有好转,但差异无显著性意义。结论抗神经内分泌治疗可以降低心肌梗死患者的血浆肾素、血管紧张素Ⅱ水平。

Objective To observe the effects of long-term anti-nuroendocrine treatment on neuroenclocrine hormones and left ventricular function of the patients with myocardial infarction accompanied by hyperglycemia. Methods Sixty five patients with myocardial infarction were divided into two groups：euglycemia group 34 patients,hyperglycaemia group 31 patients. The patients were treated with metoprolol and ACEI. The levels of neuroendocrine hormones were measured before and 6 months after the treatment. The ultrasonocardiogram was examined before and 2 years after the treatment. Results Metoprolol and ACEI could lower the levels of neuroendocrine hormones. The levels of plasma renin activity（PRA） and AngⅡ in 2 groups were lowered with statistical difference （ P 〈0.05） after the drugs were used. LVEF in euglycemia group was improved with statistical difference （ P〈0.05） after the drugs were used,but the improvement of I.VEF had no statistical difference in hyperglycaemia group after the treatment. Conclusion PRA and Ang Ⅱ of myocardial infarction patients can be decreased by hormone antagonist treatment.