糖尿病对急性ST段抬高型心肌梗死后心力衰竭的影响

Effects of Diabetes Mellitus on Heart Failure Complicated With ST-Segment Elevation Myocardial Infarction in Revascularization Settings

目的:观察糖尿病患者急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)后心力衰竭(心衰)的特点,及其与非糖尿病患者的异同。方法:以STEMI后发生心衰的患者为研究对象,选取2001-01-01至2005-12-01入住我院的此类患者1036例,搜集其临床资料、住院期间治疗和转归情况,依据是否患有糖尿病,将所有研究对象分别纳入糖尿病组(n=320)和非糖尿病组(n=716)。统计两组患者的超声心动图特点,比较两组急性期心衰的特点、治疗及转归,以logistic回归模型分析糖尿病对STEMI后急性期心源性死亡的影响。结果:糖尿病组存在多种危险因素,其多支血管病变发生率显著高于非糖尿病组(P<0.001)。超声心动图结果显示两组患者左心室射血分数、左心房以及左心室舒张末的内径、左心室收缩和舒张末容积的差异两组间无统计学意义;但两组患者二尖瓣舒张早期峰速度(E)与二尖瓣舒张晚期峰速度(A)比值<1、1～2、≥2时差异有统计学意义。Logistic回归模型调整前后,糖尿病对住院期间心源性死亡的终点风险(HR)分别为2.4(95CI1.9～3.0,P=0.007)和1.6(95CI1.3～2.1,P=0.035)。结论:糖尿病可能是冠心病患者急性心肌梗死后发生心衰的独立危险因素;糖尿病患者急性心肌梗死后早期发生心衰的程度比较重,舒张功能不全更加显著,且可能是导致其易发心衰的重要机制。

Objectives：To investigate the characteristics of heart failure in diabetic patients complicated with ST-segment elevation myocardial infarction（STEMI） and to compare them with those in non-diabetic patients. Methods：In a retrospective study,we investigated the clinical data of 1036 heart failure （HF） patients complicated with STEMI at Fuwai hospital from 2001 to 2005. Patients in the study were allocated into either diabetic group（320 cases） or non-diabetic group（716 cases ）. The clinical, echocardiographic and end-point data were recorded, and logistic regression was performed to model the association of diabetes status with outcomes. Results：Various risk factors exist in diabetic group such as females, high body mass index, STEMI and HF histories. The rate of triple vessel diseases was significantly higher in diabetic group than that in non-diabetic group. Left ventricular ejection fraction,left atrial/ventricular diameter and end-diastolic/systolic volume were not significantly different between two groups （P = NS）. In addition,there were significantly higher rates of E/A ratio 〈 1 （80.0% vs 74.5% ,P 〈0. 001 ） and ≥ 2（ 11.7% vs 6.4% ,P 〈 0. 001 ） in diabetic group than those in non-diabetic group. Diabetes mellitus was associated with markedly higher cardiac mortality during hospitalization in unadjusted （ hazard ratio [ HR ] 2.4 ; 95 % CI 1.9 - 3.0） and adjusted （ 1.6 ; 1.3 - 2. 1 ） analyses. Conclusions ： Diabetes mellitus may be an independent predictor of HF after STEMI. HF was more serious in diabetic patients complicated with STEMI than that in non-diabetic patients. The important mechanism of more frequent progression to HF in diabetic patients may be explained by serious marked diastolic dysfunction.