非糖尿病急性前壁心肌梗死患者应激性高血糖与心室重构的关系

Relationship Between Stress Hyperglycemia and Left Ventricular Remodeling After Acute Anterior Myocardial Infarction in Non-Diabetic Patients

目的:观察非糖尿病急性前壁心肌梗死合并应激性高血糖患者对左心室重构的影响。方法:非糖尿病急性Q波性前壁心肌梗死患者138例,以应激空腹血糖值分为应激性血糖≥7 mmol/L组,70例,年龄(59.6±12.9)岁;应激性血糖<7 mmol/L组,68例,年龄(54.8±15.2)岁。于心肌梗死后2周、3个月、1年分别行彩色心脏超声心动图检查,测量并计算左心室收缩末期容积、左心室舒张末期容积、左心室射血分数、心室舒张早期左心房室瓣血流峰值流速/心室舒张晚期左心房室瓣血流峰值流速(VE/VA)。观察两组患者左心室功能变化和舒张末容积改变。结果:两组患者心脏超声检查结果,与应激性血糖<7 mmol/L组比,左心室舒张末容积及左心室收缩末容积心肌梗死后12个月比2周时均分别有显著增加(P<0.01),差异有统计学意义;左心室射血分数值较心肌梗死后12个月比心肌梗死后两周时有所降低(P<0.05),差异有统计学意义。VE/VA未见明显差异(P>0.05),多因素Logistic分析显示,应激性高血糖与非糖尿病急性前壁心肌梗死患者1年后左心室舒张末容积改变独立相关。结论:非糖尿病急性前壁心肌梗死合并应激性高血糖与晚期左心室重构关系密切,为晚期左心室重构的独立预测因素。

Objective ：To investigate the relationship between stress hyperglycemia（SH） and left ventricular remodeling after acute anterior myocardial infarction（MI） in non-diabetic patients. Methods：A total of 138 non-diabetic patients diagnosed with acute Q wave anterior MI were studied. The patients were divided into two groups according to the value of SH ： Group A, SH ≥7 mmol/L, age 59. 6 ± 12.9, n = 70, and Group B, SH 〈 7 mmol/ L,age 54. 8 -＋ 15.2 ,n =68. Transthoracic Doppler echoeardiography was performed at 2 weeks,3 months and 1 year after MI to measure the left vertricular end-systolic volume（LVESV） ,left vertrieular end-diastolic volume（LVEDV） ,left vertrieular ejection fraction（LVEF） and VE/VA. The changes of left vertrieular function and LVEDV were observed in both groups. Results ：There was significant difference between two groups in end-diastolic volume （EDV）and end-systolic volume（ ESV ）after one year of MI,as EDV was 58. 2 ± 14. 8 ml/m^2 vs 67. 9 ± 15. 2ml/m^2（P 〈0. 01 ） and ESV was 27. 1 ± 8. 6 ml/m^2 vs 35. 7 ±12. 3 ml/m^2 （ P 〈 0. 01 ）. EF had significant difference between two groups after one year of MI （ 0. 53 ± 0. 10 ） vs （ 0. 50 ± 0. 12 ） （ P 〉 0. 05 ）. There was no significant difference of VE/VA（ P 〉 0. 05 ）. The multiple logistic analysis showed that the stress hyperglycemia was independently associated with the change of LVEDV in non-diabetic patients after acute anterior MI in one year. Conclusions：HS was closely related with left vertrieular remodeling, it was an independent predicator of left vertrieular remodeling after acute anterior MI in non-diabetic patients.