糖尿病对急性心肌梗死前心绞痛心肌保护作用的影响

Effects of diabetes mellitus on the myocardial protective function of preinfarctive angina pectoris in acute myocardial infarction patients

目的 探讨糖尿病 (DM)伴急性心肌梗死 (AMI)患者 ,糖尿病对梗死前心绞痛心肌保护作用的影响。方法 13 7例AMI患者分成 4组 ,Ⅰ组 :DM伴AMI患者有梗死前心绞痛 (14例 ) ;Ⅱ组 :DM伴AMI患者无梗死前心绞痛 (18例 ) ;Ⅲ组 :不伴DM的AMI患者有梗死前心绞痛 (4 3例 ) ;Ⅳ组 :不伴DM的AMI患者无梗死前心绞痛 (62例 )。比较各组患者肌酸激酶心型同工酶 (CK MB)峰值、射血分数、恶性心律失常发生率、心源性休克发生率及病死率。结果 Ⅲ组CK MB峰值明显低于Ⅰ、Ⅱ和Ⅳ组 (均为P <0 .0 5 ) ,Ⅰ、Ⅱ和Ⅳ组间无明显差异 (P >0 .0 5 )。Ⅲ组射血分数和恶性心律失常的发生率明显高于Ⅰ、Ⅱ和Ⅳ组 (均为P <0 .0 5 )。Ⅲ组无心源性休克发生 ,发生率显著低于Ⅰ、Ⅱ和Ⅳ组 (均为P <0 .0 5 )。Ⅲ组病死率最低 ,明显低于Ⅰ、Ⅱ和Ⅳ组 (均为P <0 .0 5 ) ;Ⅰ、Ⅱ和Ⅳ组病死率无显著性差异 (P >0 .0 5 )。结论 梗死前心绞痛对不伴DM的AMI患者心肌有保护作用 ,但DM伴AMI患者梗死前心绞痛的心肌保护作用不明显。

Objective To study the effects of diabetes mellitus(DM) on the myocardial protective function of preinfarctive angina pectoris in acute myocardial infarction(AMI) patients.Methods 137 AMI patients were divided into four groups.GroupⅠ:14 cases of AMI accompanied with DM,who have preinfarctive angina pectoris (AP).GroupⅡ:18 cases of AMI accompanied with DM,who have no preinfarctive AP.GroupⅢ:43 cases of AMI without DM, who have preinfarctive AP.GroupⅣ:62 cases of AMI without DM, who have no preinfarctive AP.Peak CK MB,ejective fraction,incidence of malignant arrhythmia and cardiogenic shock,mortality in four groups were compared.Results Peak CK?MB in groupⅢ was significantly lower than that in groupⅠ,ⅡandⅣ( P <0.05).Ejective fraction was significantly higher in group Ⅲ than that in group Ⅰ,ⅡandⅣ( P <0.05).The incidence rates of malignant arrhythmia and cardiogenic shock in group Ⅲ were significantly lower than those in group Ⅰ,ⅡandⅣ( P <0.05).Mortality in groupⅢ was significantly lower than that in groupⅠ,ⅡandⅣ( P <0.05).Conclusion Preinfarctive AP has myocardiac protective function in AMI patients without DM,but this function is masked in AMI patients accompanying with DM.