老年2型糖尿病患者急性心肌梗死早期血糖波动与心功能关系

Relationship between glycemic fluctuations and cardiac function in the early stage in elderly type 2 diabetic patients with acute myocardial infarction

目的探讨因急性心肌梗死住院的老年2型糖尿病患者入院早期血糖波动程度和心功能受损及恢复的关系。方法采用动态血糖监测系统测定88例老年2型糖尿病并急性心肌梗死患者早期血糖水平,根据平均血糖波动幅度分为血糖波动正常组(NGF组)18例、轻微血糖波动组(MGF组)30例和严重血糖波动组(SGF组)40例,评估3组入院时与3个月后心功能状态和超声心动图指标。结果入院时MGF组左室射血分数明显低于NGF组(P<0.01),左心室收缩末期容积明显高于NGF组(P<0.01);入院时及3个月后,SGF组KillipⅡ级及以上比例、左心室收缩末期容积和室壁运动积分指数均明显高于NGF组和MGF组,左室射血分数均明显低于NGF组和MGF组(P<0.05);3个月后NGF组和MGF组左室射血分数明显高于入院时(P<0.01),2组比较差异无统计学意义(P>0.05);SGF组超声心动图指标与治疗前比较差异无统计学意义(P>0.05)。结论老年2型糖尿病患者心肌梗死早期易出现血糖异常波动,其中严重血糖波动的患者心功能受损更严重,且不易恢复。

Objective To explore the relationship between glycemic fluctuations and cardiac dysfunction impairment and restoration in the early stage in elderly type 2 diabetic patients hospitalized for acute myocardial infarction （AMI）. Methods Continuous glucose monitoring system was used to monitor glycemic fluctuations in the early stage in 88 elderly type 2 diabetic patients hospitalized for AMI. All patients were divided into 3 groups according to mean amplitude of glycemic excursions： normal glycemic fluctuations （NGF） group （n= 18）, moderate glycemic fluctuations （MGF） group （n=30）, and severe glycemic fluctuations （SGF） group （n=40）. The cardiac function and echocardiogram results were evaluated on admission and 3 months after AMI. Results Left ventricular ejection fraction （LVEF） was significantly lower and left ventricular end-systolic volume （LVESV） was significantly higher in MGF group than that in NGF group on admission （P〈0.01）. On admission and 3 months after AMI, the proportion of Killip 11 and above, LVESV and wall motion score index （WMSI） were significantly higher and LVEF was significantly lower in SGF group compared with NGF and MGF groups （P〈0.05）. After treatment for 3 months, LVEF was significantly higher than that on admission in NGF and MGF groups （P〈0. 05）, with no significant difference between two groups （P〉0. 05）. There was no significant difference in echocardiogram indexes compared with before treatment in SGF group （P〉0.05）. Conclusion Elderly type 2 diabetic patients are very likely to present with marked glycemic fluctuations in the early stage of AMI. The cardiac function is severely impaired in the patients with severe glycemic fluctuations, which is difficult to recover.