急性心肌梗死后侧支循环的形成及糖尿病对其影响

Formation of coronary collateral circulation after acute myocardial infarction and the effect of diabetes mellitus

目的 了解急性心肌梗死 (AMI)后侧支循环形成的情况及糖尿病对其影响。方法 采用 1 996年 1 2月～ 1 999年 1 2月阜外医院介入治疗中心收治的AMI后 3个月内冠状动脉造影显示梗死相关病变仍完全闭塞者共 2 1 0例作为研究对象。回顾性分析每例患者有无侧支循环形成、侧支循环形成的时间以及侧支循环与梗死相关病变部位、梗死前心绞痛和室壁瘤形成之间的关系 ,并比较合并(48例 )与不合并糖尿病 (1 62例 )患者侧支循环形成的不同。侧支循环的评价采用计分法。结果AMI后 2周内 42 8%的患者可见侧支循环 ,第 3周达 60 0 % ,1个月时高达 75 3 % ,说明AMI后 2周即有侧支循环的形成 ,多数形成于 3～ 4周。梗死后 1～ 3个月左室造影显示有室壁瘤形成的 1 1例非糖尿病AMI患者中只有 2例可见侧支循环 (1 8 2 % ) ,而无室壁瘤形成的 87例非糖尿病AMI患者中 83例可见侧支循环 (95 4% )。与非糖尿病患者相比 ,合并糖尿病的AMI患者梗死后第 4周方可见侧支循环。 48例糖尿病患者侧支循环计分平均 0 35 ,只有 9例可见侧支循环 (1 8 8% ) ;而 1 62例非糖尿病患者侧支循环计分平均 2 42 ,1 4 0例有侧支循环形成 (86 4% )。结论 AMI后如梗死相关病变仍完全闭塞 ,绝大多数于 3～ 4周形成侧支循环。

Objective To investigate the formation of coronary collateral circulation after acute myocardial infarction (AMI)and effect of diabetes mellitus on it Methods 210 AMI patients (48 diabetic and 162 nondiabetic), whose infarction related arteries were still occluded shown by coronary angiography performed within 3 months after AMI, were studied Coronary angiogram was carefully analyzed and collateral circulation scored according to Rentrop scoring system in both diabetic and nondiabetic patients Results Collateral circulation started to form at week 2 (42 8%) post acute MI, increasing grandually and reached its peak (75 3%) at week 4 It was freely formed even in nondiabetic patients with left ventricular aneurysm (18 2%) Compared with nondiabetic patients, diabetic patients had less collateral circulation (18 8%), which was also formed later by 1 2 weeks Conclusion Collateral circulation is formed at 3 4 weeks after AMI in most nondiabetic patients Diadetes mellitus is an important factor affacting collateral circulation development