缺血后适应对急性心肌梗死合并糖尿病患者临床及预后的影响

Clinical and Prognosis Effect of Myocardial Ischemic on Acute Myocardial Infarction Patients with Diabetes Mellitus

目的探讨心肌缺血后适应对急性心肌梗死(AMI)合并糖尿病患者临床及预后的影响。方法选择首次发生AMI且合并糖尿病患者32例及AMI不合并糖尿病患者35例,均于PCI术中设置缺血后适应方式;对照组37例AMI行常规PCI术。测定3组术前及术后肌酸激酶(CK)及肌酸激酶同工酶(CK-MB)水平;测量术后3个月左心室舒张期末容积指数(LVEDVI)、左心室收缩期末容积指数(LVESVI)、左心室射血分数(LVEF);观察术后严重心律失常、梗死后心绞痛、住院期间病死率发生情况。结果与常规治疗组比较,后适应组术后CK及CK-MB峰值水平明显减低,术后3个月左心室容积减小;严重心律失常、梗死后心绞痛后适应组明显减低(P<0.05)。且上述指标在非糖尿病后适应组较糖尿病后适应组改善明显,差异有统计学意义(P<0.05)。3组患者住院期间病死率间差异无统计学意义(P>0.05)。结论心肌缺血后适应对AMI心肌有保护作用,能改善患者预后,但对合并糖尿病AMI患者保护作用减弱。

Objective To evaluate the effect of ischemic on clinical course and prognosis in patients with myocardial infarction accompanied diabetes mellitus during percutaneous coronary intervention.Methods A total of 104 enrolled patients with AMI were divided into three groups：32 patients accompanied diabetes mellitus（group 1） and 35 patients without diabetes mellitus（group 2） were treated with PCI operation set schemic postconditioning way and 37 control patients with AMI（group 3）were treated with conventional PCI opetation.The level of plasma CK and CK-MB were detected before and after the operation.The indices of left ventricular end diastolic volume index（LVEDVI）,left ventricular end systolic volume index（LVESVI） and left ventricular ejection fraction（LVEF） were measured by ultrasonic cardiogram three months after the onset of AMI.Malignant arrhythmia,angina occurred after AMI and death rate in hospital were compared among the three groups.Results The peak level of plasma CK and CK-MB were lower in PC group（group 1 and group 2） compared with those in NPC group（group3）.The parameters of cardiac performance decreased significantly in PC group compared with those in NPC group.Significant difference was found in left ventricular end diastolic volume index,left ventricular end systolic volume index and left ventricular ejection fraction in PC group 3 months after PCI.The incidence of malignant arrhythmia and angina after AMI were lower in PC group compared with that in NPC group（P0.05）.After postconditioning the symptoms of all the indices of the patients in group 2 had been improved a lot than those of the patients in group 1（P0.05）.The difference in the death rate in hospital was not significant among the three groups（P0.05）.Conclusion Ischemic postcondition has the effect of cardioprotection in patients with acute myocardial infarction during percutaneous coronary intervention.But the effect of cardioprotection is lower in patients with acute myocardial infarction accompanied diabetes mellitus.