二甲双胍预防糖尿病合并心肌梗死患者再梗死的效果评价

Efficacy of Metformin in Prevention of Reinfarction in Diabetes Patients with Myocardial Infarction

目的探讨二甲双胍用于预防糖尿病合并心肌梗死患者再梗死的临床效果。方法将145例糖尿病合并心肌梗死患者按治疗方法的不同分为对照组(71例)和观察组(74例)。2组患者均进行心肌梗死的标准康复治疗,在此基础上对照组给予胰岛素进行降糖治疗,观察组在对照组治疗的基础上加用二甲双胍治疗。观察比较2组患者治疗1年后心肌再梗死、ST段抬高型心肌梗死(STEMI)和非ST段抬高型心肌梗死(非STEMI)的发生率;同时以左室射血分数(LVEF)、左室收缩末期内径(LVESD)及左窒舒张末期内径(LVEDD)评价2组患者的心功能及不良反应的发生情况。结果治疗1年后,对照组再梗死发生率及STEMI发生率分别为15.5%、12.7%;观察组再梗死发生率及STEMI发生率分别为4.1%、2.7%,对照组再梗死发生率及STEMI发生率均明显高于观察组(均P<0.05)。2组非STEMI发生率比较差异无统计学意义(P>0.05)。观察组LVEF、LVESD和LVEDD的改善程度均高于对照组(均P<0.05)。2组患者均未出现严重不良反应,无死亡病例。结论对糖尿病合并心肌梗死患者使用二甲双胍治疗有助于预防再梗死发生和提高心室功能。

Objective To investigate the clinical efficacy of metformin in the prevention of reinfarction in diabetes patients with myocardial infarction（MI）. Methods A total of 145 diabetes patients with MI were given standard rehabilitation treatment. In addition, these patients were treated with insulin alone（control group,71 patients） or in combination with metformin（observation group,74 patients）. The incidences of reinfarction, ST-segment elevation MI （STEMI） and non- ST-segment elevation MI（NSTEMI） were recorded after treatment for 1 year. Furthermore,left ventrieular ejection fraction（LVEF） ,left ventricular end-systolic diameter（LVESD）, left ventricular end-diastolic diameter（LVEDD） and adverse reactions were observed in both groups. Results After treatment for 1 year,the incidences of reinfarction and STEMI in control group were significantly higher than those in observation group（15.5% vs 4.1% and 12.7% vs 2.7% ,respectively; all P〈0.05）. There was no significant difference in the incidence of NSTEMI between the two groups（P〉0.05）. Compared with control group, the LVEF, LVESD and LVEDD were significantly improved in observation group（all P〈0. 05）. No severe adverse reactions and death occurred in both groups. Conclusion The treatment with metformin can prevent the occurrence of reinfarction and improve the ventricular function in diabetes patients with MI.