心肌梗死合并糖尿病患者QT间期和QT离散度的改变及不同治疗方法对其的影响

QT-interval and its dispersion in type 2 diabetic and non-diabetic patients with post-myocardial infarction and effects of different hypoglycemic drugs on QT-interval dispersion.

目的比较心肌梗死后合并糖尿病及未合并糖尿病患者的QT间期（QTc）及QT离散度（QTcd），并比较心肌梗死后糖尿病患者分别用胰岛素、磺脲类药物、双胍类及饮食控制后的QTc、QTcd。方法138例心肌梗死后患者分为糖尿病组（70例）及非糖尿病组（68例），行同步12导联心电图，测定QTc及QTcd。糖尿病组分别给予胰岛素、磺脲类药物、双胍类及饮食控制后测定QTc及QTcd。结果糖尿病组的QTc、QTcd显著高于非糖尿病组[（377．2±24．3）ms与（342．9±27．5）ms、（48．8±19．7）ms与（40．3±26．6）ms，t分别为7．77、2．14，P〈0．01或0．05]，双胍类药物组与饮食控制组QTc、QTcd比较差异无统计学意义（P均〉0．05），胰岛素组QTc、QTcd显著高于其他3纽（P〈0．05或0．01），磺脲类药物组QTc、QTcd高于双胍类药物组及饮食控制组（P〈0．05或0．01）。结论心肌梗死后糖尿病患者QTcd增加，提示心肌梗死后糖尿病患者的病死率高。胰岛素和格列吡嗪可能会增加心肌梗死后糖尿病患者QTcd，且在胰岛素治疗后更明显。

Objective To compare the QTc and QTcd between type 2 diabetic and non-diabetic patients with post-myocardial infarction （post-MI） ,and to compare the QTcd in type 2 diabetic patients with post-MI treated with insulin, sulfonylurea, metformin, or diet alone. Methods We measured the QTc and QTcd through simultaneous 12-lead Electrocardiogram in 138 post-MI patients,including 70 type 2 diabetic （of which,23 were assigned to receive insulin ,20 glipizide, 16 metformin, 11 diet control） and 68 non-diabetic patients. Result Compared with post- MI patients without diabetes, those with type 2 diabetes had significantly higher QTc [ （ 377.2 ± 24. 3 ） ms vs （342.9 ±27.5）ms,t =7.79,P 〈0.01 ] and QTcd [ （48.8 ± 19.7）ms vs （40.3 ±26.6）ms,t =2.14,P 〈0.05]. There were no significant difference between the metformin group and the diet control group （ P 〉 0.05 ）. The QTc and QTed in the insulin group were significantly higher than those in the other three group s （P 〈 0.05 ）, and the QTc and QTed in the glipizide group were higher than those in the metformin group or diet control group （ P 〈 0.05, and P 〈 0.01 ,respectively）. Conclusion Type 2 diabetes is associated with an additional increase in the QTed in post- MI patients,suggesting higher mortality risk in post-MI patients with type 2 diabetes. Insulin and glipizide may increase the QTc and QTed in post-MI patients with diabetes. These effects were more significant in the insulin therapy group.