Diabetes mellitus, revascularization and outcomes in elderly patients with myocardial infarction-related cardiogenic shock

Background The prognostic role of diabetes mellitus(DM)in elderly patients with myocardial infarction-related cardiogenic shock(MI-CS)remains controversial.Little information exists about the impact of intensive cardiac care unit(ICCU)and revascularization on outcomes of elderly patients with MI-CS.We aimed to assess the prognostic impact of DM according to age in patients with MI-CS,and to analyze the impact ICCU management and revascularization on in-hospital mortality in MI-CS patients at older ages.Methods Discharge episodes with diagnosis of CS associated with MI were selected from the Spanish National Health System’s Basic Data Set.Centers were classified according to their availability of ICCU.Main outcome measured was in-hospital mortality.Results A total of 23,590 episodes of MI-CS were identified,of whom 12,447(52.8%)were in patients aged≥75 years.The impact of DM on in-hospital mortality was different among age subgroups.While in younger patients,DM was associated to a higher mortality risk(0.52 vs.0.47,OR=1.12,95%CI:1.06–1.18,χ^2<0.001),this association became non-significant in older patients(0.76 vs.0.81,χ^2=0.09).Adjusted mortality rate of MI-CS aged≥75 years was lower in patients admitted to hospitals with ICCU(adjusted mortality rate:74.2%vs.77.7%,P<0.001)and in patients undergoing revascularization(74.9%vs.77.3%,P<0.001).Conclusions Prognostic impact of DM in patients with MI-CS was different according to age,with a significantly lower impact at older ages.The availability of ICCU and revascularization were associated with better outcomes in these complex patients.

Long-term quality-of-care score for predicting the occurrence of acute myocardial infarction in patients with type 2 diabetes mellitus

BACKGROUND Cardiovascular disease(CVD)is the leading cause of death globally,and diabetes mellitus(DM)is a well-established risk factor.Among the risk factors for CVD,DM is a major modifiable factor.In the fatal CVD outcomes,acute myocardial infarction(AMI)is the most common cause of death.AIM To develop a long-term quality-of-care score for predicting the occurrence of AMI among patients with type 2 DM on the basis of the hypothesis that good quality of care can reduce the risk of AMI in patients with DM.METHODS Using Taiwan’s Longitudinal Cohort of Diabetes Patients Database and the medical charts of a medical center,we identified incident patients diagnosed with type 2 DM from 1999 to 2003 and followed them until 2011.We constructed a summary quality-of-care score(with values ranging from 0 to 8)with process indicators(frequencies of HbA1c and lipid profile testing and urine,foot and retinal examinations),intermediate outcome indicators(low-density lipoprotein,blood pressure and HbA1c),and co-morbidity of hypertension.The associations between the score and the incidence of AMI were evaluated using Cox regression models.RESULTS A total of 7351 patients who had sufficient information to calculate the score were enrolled.In comparison with participants who had scores≤1,those with scores between 2 and 4 had a lower risk of developing AMI[adjusted hazard ratio(AHR)=0.71;95% confidence interval(95%CI):0.55-0.90],and those with scores≥5 had an even lower risk(AHR=0.37;95%CI:0.21-0.66).CONCLUSION Good quality of care can reduce the risk of AMI in patients with type 2 DM.The quality-of-care score developed in this study had a significant association with the risk of AMI and thus can be applied to guiding the care for these patients.

Effects of glucagon-like peptide 1 analogs in combination with insulin on myocardial infarct size in rats with type 2 diabetes mellitus

AIM To evaluate the effects of glucagon-like peptide-1 analogs(GLP-1 a) combined with insulin on myocardial ischemiareperfusion injury in diabetic rats.METHODS Type 2 diabetes mellitus(T2 DM) was induced in maleWistar rats with streptozotocin(65 mg/kg) and verified using an oral glucose tolerance test. After anesthesia, the left coronary artery was occluded for 40 min followed by 80 min reperfusion. Blood glucose level was measured during surgery. Rats were randomized into six groups as follows:(1) control rats;(2) insulin(0.1 U/kg) treated rats prior to ischemia;(3) insulin(0.1 U/kg) treated rats at reperfusion;(4) GLP-1 a(140 mg/kg) treated rats prior to ischemia;(5) GLP-1 a(140 mg/kg) treated rats at reperfusion; and(6) rats treated with GLP-1 a(140 mg/kg) prior to ischemia plus insulin(0.1 U/kg) at reperfusion. Myocardial area at risk and infarct size was measured planimetrically using Evans blue and triphenyltetrazolium chloride staining, respectively.RESULTS There was no significant difference in the myocardial area at risk among groups. Insulin treatment before ischemia resulted in a significant increase in infarct size(34.7% ± 3.4% vs 18.6% ± 3.1% in the control rats, P < 0.05). Post-ischemic administration of insulin or GLP-1 a had no effect on infarct size. However, pre-ischemic administration of GLP-1 a reduced infarct size to 12% ± 2.2%(P < 0.05). The maximal infarct size reduction was observed in the group treated with GLP-1 a prior to ischemia and insulin at reperfusion(8% ± 1.6%, P < 0.05 vs the control and GLP-1 a alone treated groups).CONCLUSION GLP-1 a pre-administration results in myocardial infarct size reduction in rats with T2 DM. These effects are maximal in rats treated with GLP-1 a pre-ischemia plus insulin at reperfusion.

Predictors and in-hospital prognosis of recurrent acute myocardial infarction

Objective To investigate the contributing factors and in-hospital prognosis of patients with or without recurrent acute myocardial infarction （AMI）. Methods A total of 1686 consecutive AMI patients admitted to Peking University People＇s Hospital from January 2010 to December 2015 were recruited. Their clinical characteristics were retrospectively compared between patients with or without a recurrent AMI. Then multivariable logistic regression was used to estimate the predictors of recurrent myocardial infarction. Results Recurrent AMI patients were older （69.3 ± 11.5 vs. 64.7 ± 12.8 years, P 〈 0.001） and had a higher prevalence of diabetes mellitus （DM） （52.2% vs. 35.0%, P 〈 0.001） compared with incident AMI patients, they also had worse heart function at admission, more severe coronary disease and lower reperfusion therapy. Age （OR = 1.03, 95% CI： 1.02-1.05; P 〈 0.001）, DM （OR = 1.86, 95% CI： 1.37-2.52; P 〈 0.001） and reperfusion therapy （OR = 0.74; 95% CI： 0.52-0.89; P 〈 0.001） were independent risk factors for recurrent AMI Recurrent AMI patients had a higher in-hospital death rate （12.1% vs. 7.8%, P = 0.039） than incident AMI patients. Conclusions Recurrent AMI patients presented with more severe coronary artery conditions. Age, DM and reperfusion therapy were independent risk factors for recurrent AMI, and recurrent AM1 was related with a high risk of in-hospital death.

Type 2 diabetes is associated with a worse functional outcome of ischemic stroke

AIM: To assess whether ischemic stroke severity and outcome is more adverse in patients with type 2 diabetes mellitus(T2DM). METHODS: Consecutive patients hospitalized for acute ischemic stroke between September 2010 and June 2013 were studied prospectively(n = 482; 40.2% males, age 78.8 ± 6.7 years). T2 DM was defined as self-reported T2 DM or antidiabetic treatment. Stroke severity was evaluated with the National Institutes of Health Stroke Scale(NIHSS) score at admission. The outcome was assessed with the modified Rankin scale(m RS) score at discharge and with in-hospital mortality. Adverse outcome was defined as m RS score at discharge ≥ 2 or in-hospital death. The length of hospitalization was also recorded.RESULTS: T2 DM was present in 32.2% of the study population. Patients with T2 DM had a larger waist circumference, higher serum triglyceride and glucose levels and lower serum high-density lipoprotein cholesterol levels as well as higher prevalence of hypertension, coronary heart disease and congestive heart failure than patients without T2 DM. On the other hand, diabetic patients had lower low-density lipoprotein cholesterol levels and reported smaller consumption of alcohol than non-diabetic patients. At admission, the NIHSS score did not differ between patients with and without T2DM(8.7 ± 8.8 and 8.6 ± 9.2, respectively; P = NS). At discharge, the m RS score also did not differ between the two groups(2.7 ± 2.1 and 2.7 ± 2.2 in patients with and without T2 DM, respectively; P = NS). Rates of adverse outcome were also similar in patients with and without T2DM(62.3% and 58.5%, respectively; P = NS). However, when we adjusted for the differences between patients with T2 DM and those without T2 DM in cardiovascular risk factors, T2 DM was independently associated with adverse outcome [relative risk(RR) = 2.39; 95%CI: 1.21-4.72, P = 0.012]. Inhospital mortality rates did not differ between patients with T2 DM and those without T2DM(9.0% and 9.8%, respectively; P = NS). In multivariate analysis adjusting for the difference in cardiovascular risk factors between the two groups, T2 DM was again not associated with in-hospital death. CONCLUSION: T2 DM does not appear to affect ischemic stroke severity but is independently associated with a worse functional outcome at discharge.

Comment on: Statin use and risk of diabetes mellitus

In manuscript named "Statin use and risk of diabetes mellitus" by Chogtu et al, authors defined that pravastatin 40 mg/dL reduced the risk of diabetes by 30% in West of Scotland Coronary Prevention study. In fact, pravastatin 40 mg/d L reduced coronary heart disease risk approximately 30% in mentioned study.

Impact of conditioning hyperglycemic on myocardial infarction rats:Cardiac cell survival factors

While clinical data have suggested that the diabetic heart is more susceptible to ischemic heart disease(IHD),animal data have so far pointed to a lower probability of IHD. Thus,the aim of this present review is to look at these conflicting results and discuss the protective mechanisms that conditioned hyperglycemia may confer to the heart against ischemic injury. Several mechanisms have been proposed to explain the cardioprotective action of high glucose exposure,namely,upregulation of anti-apoptotic factor Bcl-2,inactivation of pro-apoptotic factor bad,and activation of pro-survival factors such as protein kinase B(Akt),vascular endothelial growth factor(VEGF),hypoxia inducible factor-1α and protein kinase C-ε. Indeed,cytosolic increase in Ca2+ concentration,the mitochondrial permeability transition pore,plays a key role in the genesis of ischemic injury. Previous studies have shown that the diabetic heart decreased Na+/Ca2+ and Na+/H+ exchanger activity and as such it accumulates less Ca2+ in cardiomyocyte,thus preventing cardiac injury and the associated heart dysfunctions. In addition,the expression of VEGFin diabetic animals leads to increased capillary density before myocardial infarction. Despite poor prognostic in the long-term,all these results suggest that diabetes mellitus and consequently hyperglycemia may indeed play a cardioprotective role against myocardial infarction in the short term.

Dapagliflozin in heart failure and type 2 diabetes:Efficacy,cardiac and renal effects,safety

BACKGROUND Heart failure(HF),especially HF with reduced ejection fraction(HFrEF),presents complex challenges,particularly in the aging population where it often coexists with type 2 diabetes mellitus(T2DM).AIM To analyze the effect of dapagliflozin treatment on cardiac,renal function,and safety in patients with HFrEF combined with T2DM.METHODS Patients with T2DM complicated with HFrEF who underwent treatment in our hospital from February 2018 to March 2023 were retrospectively analyzed as the subjects of this study.The propensity score matching method was used,and a total of 102 eligible samples were scaled.The clinical efficacy of the two groups was evaluated at the end of the treatment,comparing the results of blood glucose,insulin,cardiac function,markers of myocardial injury,renal function indexes,and 6-min walk test(6MWT)before and after the treatment.We compared the occurrence of adverse effects on the treatment process of the two groups of patients.The incidence of adverse outcomes in patients within six months of treatment was counted.RESULTS The overall clinical efficacy rate of patients in the study group was significantly higher than that of patients in the control group(P=0.013).After treatment,the pancreatic beta-cell function index,left ventricular ejection fraction,and glomerular filtration rate of patients in the study group were significantly higher than control group(P<0.001),while their fasting plasma glucose,2-h postprandial glucose,glycosylated hemoglobin,insulin resistance index,left ventricular end-systolic diameter,left ventricular end-diastolic diameter,cardiac troponin I,creatine kinase-MB,N-terminal pro b-type natriuretic peptide,serum creatinine,and blood urea nitrogen were significantly lower than those of the control group.After treatment,patients in the study group had a significantly higher 6MWT than those in the control group(P<0.001).Hypoglycemic reaction(P=0.647),urinary tract infection(P=0.558),gastrointestinal adverse effect(P=0.307),respiratory disturbance(P=0.558),and angioedema(P=0.647)were not statistically different.There was no significant difference between the incidence of adverse outcomes between the two groups(P=0.250).CONCLUSION Dapagliflozin significantly enhances clinical efficacy,cardiac and renal function,and ambulatory capacity in patients with HFrEF and T2DM without an increased risk of adverse effects or outcomes.

C反应蛋白/白蛋白比值对2型糖尿病合并急性心肌梗死患者远期不良心脑血管事件的预测价值研究

背景急性心肌梗死(AMI)是威胁全球公众健康的主要原因之一。虽然已有相应的再灌注治疗策略,但AMI相关的主要不良心脑血管事件(MACCEs)仍然是全世界人口死亡的原因之一。尤其合并糖尿病的AMI患者,因冠状动脉病变复杂,病变程度严重,尽早发现和判断该部分患者远期预后相对困难,因此寻找相对简便、易获得的实验室指标,有利于为2型糖尿病(T2DM)合并AMI患者经皮冠状动脉介入(PCI)术后MACCEs的预测提供依据。目的探讨血清C反应蛋白(CRP)/白蛋白(Alb)比值(CAR)对T2DM合并AMI患者PCI术后远期MACCEs的预测价值。方法纳入2014—2019年就诊于宁夏医科大学总医院心血管内科1683例T2DM合并AMI患者为研究对象,收集患者的一般临床资料与检查结果。对所有患者进行电话或门诊随访,以全因死亡、非致死性心肌梗死、再发不稳定型心绞痛、非致死性脑卒中、新发心力衰竭或心力衰竭加重再入院、再次血运重建作为MACCEs。根据患者随访期间是否发生MACCEs分为MACCEs组(508例)和非MACCEs组(1175例)。采用单因素及多因素Logistic回归分析探讨T2DM合并AMI患者MACCEs事件的影响因素。采用Kaplan-Meier法绘制患者的生存曲线,生存曲线的比较采用Log-rank检验。采用受试者工作特征(ROC)曲线分析CAR对T2DM合并AMI患者远期发生MACCEs的预测效能,使用净重分类改善指标(NRI)和综合判别指数(IDI)评价CAR对T2DM合并AMI患者预后评估的改善效果。结果1683例患者中508例(30.18%)患者发生MACCEs。多因素Logistic回归分析显示高血压病[OR(95%CI)=1.994(1.142~3.483)]、冠状动脉植入支架长度[OR(95%CI)=1.031(1.002~1.062)]、CRP[OR(95%CI)=0.950(0.915~0.986)]、Alb[OR(95%CI)=0.933(0.880~0.989)]及CAR[OR(95%CI)=5.582(1.705~18.277)]是T2DM合并AMI患者PCI术后发生MACCEs的影响因素(P<0.05)。根据CAR中位表达水平(0.86),将患者分为CAR<0.86组和CAR≥0.86组,Log-rank检验结果显示,CAR≥0.86组MACCEs发生率高于CAR<0.86组(52.68%与22.92%;χ^(2)=65.65,P<0.001)。ROC曲线显示CAR预测T2DM合并AMI患者发生MACCEs的ROC曲线下面积为0.728(95%CI=0.702~0.754),最佳截断值为0.576,灵敏度为0.617,特异度为0.747。在基线模型基础上,与CRP、Alb相比,CAR能明显改善对患者发生MACCEs的预测效果(NRI=0.377,IDI=0.166,C指数=0.690;P<0.05)。结论CAR是T2DM合并AMI患者PCI术后远期MACCEs发生风险的有效预测指标。

75岁以下非瓣膜性心房颤动病人脑卒中高危因素分析

目的:探讨75岁以下非瓣膜性心房颤动病人发生脑卒中、动脉血栓栓塞事件的高危因素。方法:通过心电图纳龙系统筛选2018年1月—2021年12月在郑州市中心医院住院的75岁以下的心房颤动病人1926例,查阅电子病历系统剔除合并瓣膜性心脏病、严重肝肾功能不全、凝血功能障碍的病人;最终纳入病人1616例,其中合并脑卒中病人446例作为脑卒中组,余1170例病人作为对照组。通过电子病历系统收集相关资料:病人是否合并心力衰竭、高血压、糖尿病、血管疾病、年龄及性别、心率(心房颤动发作或持续时)。因心房颤动病人卒中风险评分(CHA2DS2-VASc)将年龄65~75岁计为1分,缺血风险增加,故本研究将65岁作为界值,列为研究因素。采用二元Logistic回归分析非瓣膜性心房颤动病人发生脑卒中的危险因素,受试者工作特征(ROC)曲线分析高危因素对非瓣膜性心房颤动病人发生脑卒中的预测效能。结果:脑卒中组合并高血压、糖尿病及年龄65~75岁病人构成比高于对照组,心率低于对照组,差异均有统计学意义(P<0.01)。二元Logistic回归分析显示,合并高血压、糖尿病、年龄65~75岁心房颤动病人发生脑卒中风险均显著增高;心率每下降1次/min,脑卒中风险增加0.6%。ROC曲线显示,合并高血压、糖尿病病史、年龄65~75岁、低心率联合预测脑卒中发生风险增高(P<0.05)。结论:心房颤动病人合并高血压、糖尿病、年龄65~75岁、低心率均增加罹患脑卒中风险,若4种高危因素同时发生,心房颤动病人脑卒中罹患风险更高,较好地控制血压、血糖,适当调整心率可能降低心源性脑卒中相关致死率和致残率。

Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke

Timely diagnosis and control of cardiovascular risk factors is a priority objective for adequate primary and secondary prevention of acute stroke. Hypertension, atrial fibrillation and diabetes mellitus are the most common risk factors for acute cerebrovascular events, although novel risk factors, such as sleep-disordered breathing, inflammatory markers or carotid intima-media thickness have been identified. However, the cardiovascular risk factors profile differs according to the different subtypes of ischemic stroke. Atrial fibrillation and ischemic heart disease are more frequent in patients with cardioembolic infarction, hypertension and diabetes in patients with lacunar stroke, and vascular peripheral disease, hypertension, diabetes, previous transient ischemic attack and chronic obstructive pulmonary disease in patients with atherothrombotic infarction. This review aims to present updated data on risk factors for acute ischemic stroke as well as to describe the usefulness of new and emerging vascular risk factors in stroke patients.

Exacerbated VEGF up-regulation accompanies diabetes-aggravated hemorrhage in mice after experimental cerebral ischemia and delayed reperfusion

Reperfusion therapy is the preferred treatment for ischemic stroke,but is hindered by its short treatment window,especially in patients with diabetes whose reperfusion after prolonged ischemia is often accompanied by exacerbated hemorrhage.The mechanisms underlying exacerbated hemorrhage are not fully understood.This study aimed to identify this mechanism by inducing prolonged 2-hour transient intraluminal middle cerebral artery occlusion in diabetic Ins2Akita/+mice to mimic patients with diabetes undergoing delayed mechanical thrombectomy.The results showed that at as early as 2 hours after reperfusion,Ins2Akita/+mice exhibited rapid development of neurological deficits,increased infarct and hemorrhagic transformation,together with exacerbated down-regulation of tight-junction protein ZO-1 and upregulation of blood-brain barrier-disrupting matrix metallopeptidase 2 and matrix metallopeptidase 9 when compared with normoglycemic Ins2+/+mice.This indicated that diabetes led to the rapid compromise of vessel integrity immediately after reperfusion,and consequently earlier death and further aggravation of hemorrhagic transformation 22 hours after reperfusion.This observation was associated with earlier and stronger up-regulation of pro-angiogenic vascular endothelial growth factor(VEGF)and its downstream phospho-Erk1/2 at 2 hours after reperfusion,which was suggestive of premature angiogenesis induced by early VEGF up-regulation,resulting in rapid vessel disintegration in diabetic stroke.Endoplasmic reticulum stress-related pro-apoptotic C/EBP homologous protein was overexpressed in challenged Ins2Akita/+mice,which suggests that the exacerbated VEGF up-regulation may be caused by overwhelming endoplasmic reticulum stress under diabetic conditions.In conclusion,the results mimicked complications in patients with diabetes undergoing delayed mechanical thrombectomy,and diabetes-induced accelerated VEGF up-regulation is likely to underlie exacerbated hemorrhagic transformation.Thus,suppression of the VEGF pathway could be a potential approach to allow reperfusion therapy in patients with diabetic stroke beyond the current treatment window.Experiments were approved by the Committee on the Use of Live Animals in Teaching and Research of the University of Hong Kong[CULATR 3834-15(approval date January 5,2016);3977-16(approval date April 13,2016);and 4666-18(approval date March 29,2018)].

Efficacy of Traditional Chinese Medicine in patients with acute myocardial infarction suffering from diabetes mellitus

OBJECTIVE: To investigate the "real world" effectiveness of Traditional Chinese Medicine(TCM) in patients with acute myocardial infarction suffering from diabetes mellitus(AMI+DM patients).METHODS: This was a retrospective cohort study.During hospitalization, the "exposure group" was defined as patients who had a TCM injection for ≥ 7 d.During follow-up, the definition of the exposure group was application of a Chinese patent medicine or decoction of Chinese medicine for ≥ 28 d.General information(age, sex, contact details), TCM use and endpoint events of AMI+DM patients during hospitalization and follow-up were collected.The correlation between TCM and the end-point events of AMI + DM patients was analyzed using a multiple logistic regression method.RESULTS: A total of 479 AMI + DM patients were enrolled and 345 cases were followed up. During hospitalization, TCM, age, hypertension and use of an angiotensin-converting enzyme inhibitor(ACEI)or angiotensin receptor blocker(ARB) were associated with cardiac death. During follow-up, TCM was associated with cardiac death. TCM was a relevant factor for a composite endpoint of re-infarction and stroke. TCM, anti-thrombotic therapy and lipid-lowering therapy were related to acute heart failure. TCM, anti-thrombotic therapy, anti-MI therapy and ACEI/ARB use exhibited a strong correlation with re-hospitalization due to cardiovascular disease.CONCLUSION: TCM reduced the prevalence of cardiac death during hospitalization, and cardiac death, a composite endpoint of re-infarction and stroke, acute heart failure and re-hospitalization due to cardiovascular disease during follow-up.

Vorapaxar in patients with diabetes mellitus and previous myocardial infarction: Findings from the thrombin receptor antagonist in secondary prevention of atherothrombotic ischemic events-TIMI 50 trial

Background Vorapaxar reduces cardiovascular death, myocardial infarction （MI）, or stroke in patients with previous MI while increasing bleeding. Patients with diabetes mellitus （DM） are at high risk of recurrent thrombotic events despite standard therapy and may derive particular benefit from antithrombotic therapies. The Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events-TIMI 50 trial was a randomized, double-blind, placebo-controlled trial of vorapaxar in patients with stable atherosclerosis.

Application Potential of Probiotics in Acute Myocardial Infarction

Myocardial infarction(MI)is associated with high rates of death and disability,and is the main cause of death due to cardiovascular disease and the most frequent cause of death in the developed world.Recent studies have shown that,in addition to traditional risk factors,such as hypertension,diabetes,hyperlipidemia,obesity,smoking and the environment,the gut microbiota plays an important role in MI development and progression.The discovery of an enteric-cardioid axis provides a new route to examine the complex mechanism of MI and has become a research hotspot in recent years.Experiments have suggested that probiotics decrease ischemia/reperfusion injury and inflammation,regulate lipid metabolism and decrease the myocardial infarction area.In this review,we discuss the relationship between probiotics and MI as well as potential underlying mechanisms,to provide new ideas for the prevention and treatment of MI.

Influence of age on prevalence rates of chronic complications of hospitalized aged patients with hypertension -- analysis of 17,682 cases

Objective To understand the relationship between age and chronic complications in hospitalized aged patients with hypertension, to provide evidence for hypertension prevention and control. Methods To retrospectively analyze the clinical and laboratory data on 17,682 patients with essential hypertension during Jan 1 s,, 1993-Dec 12th, 2008 in PLA general hospital. Results 1） Among all of the inrolled cases, those aged 60-64 account for 27.87%, 65-69 years group account for 26.55%, 70-74 years group accounted for 23.96%, 75-79 years group accounted for 14.14%, 80-84 years group accounted for 5.26%, 85-89 years group accounted for 1.69%, 〉 90 years accounted for 0.41%. 2） The prevalence rate of chronic complications in 60-69 years group were 31.3-31.2% for diabetes and,22.6-27.0% for cerebrovascular disease, 9.5-11.1% for myocardial infarction, 6.7-9.1% for heart failure, 5.8-6.0% for renal dysfanction 4.9-6.8% for atrial fibrillation, 0.1-0.3% for multiple organ dysfunction syndrome （MODS） in the elderly（P 〈0.05 ）. 3） The first four complications of hypertension were diabetes（33.5%）, cerebrovascular disease （31.9%）, myocardial infarction（13.2%） and heart failure（12.3%） in 70-74 years group （P〈0.05）, cerebrovascular disease （42.8%）, diabetes （32.8%）, heart failure （16.5%） and myocardial infarction（15.9%） in 75-79 years group （P〈0.05）, cerebrovascular disease （45.4%）, diabetes （35.0%）, heart failure （21.1%） and myocardial infarction（l 5.9%） in 80-84 years group （P〈0.05）, cerebrovascular disease（42.5%）, diabetes （35.8%）, heart failure （23.1%） and renal dysfanction （17.7%） in 85-89 years group（P〈0.05 ）,and cerebrovascular disease （45. 2%）, heart failure（31.5%） , diabetes （26.0%） and renal dysfanction （20.5%） in patients more than 90 years group （P〈0.05）. Conclusions The prevalence rate and kinds of chronic complications in hospitalized aged patients with hypertension were changed with the increasing age, and the first kind of complication is cerebrovascular disease. It is of more importance to prevent the occurrence of renal dysfanction and heart failure in those hypertension patients who were more than 80 years old.

钠-葡萄糖协同转运蛋白2抑制剂对急性心肌梗死合并2型糖尿病患者临床指标及预后的影响

目的观察钠-葡萄糖协同转运蛋白2抑制剂(SGLT-2i)对急性心肌梗死(AMI)合并2型糖尿病(T2DM)患者临床指标及预后的影响。方法回顾性选取2020年1月至2022年6月于安徽医科大学第二附属医院胸痛中心就诊后确诊AMI合并T2DM患者180例,根据入院后降糖方案分为对照组(79例,给予磺脲类、α-糖苷酶抑制剂、二甲双胍等药物)和观察组(101例,给予达格列净或恩格列净)。患者出院后定期随访,比较2组患者临床指标及主要不良心血管事件(MACE)发生情况。结果所有患者随访6~12个月,结果显示观察组白细胞计数小于对照组[(7.4±1.6)×10^(9)/L比(8.7±1.6)×10^(9)/L],左心室舒张末期内径改善优于对照组[(-0.527±1.462)mm比(1.359±2.111)mm](均P<0.05)。观察组MACE发生率低于对照组[5.4%(2/37)比25.0%(8/32)],差异有统计学意义(P=0.020)。结论SGLT-2i较其他降糖药物12个月内能改善AMI合并T2DM患者的心脏功能及预后,且能减轻该类患者的全身炎症反应。

Anticardiolipin antibodies do not mediate macrovascular complications of type 2 diabetes

The relationship of anticardiolipin antibodies (ACA), markers of the antiphospholipid syndrome, with vascular complications of diabetes mellitus is polemic. This cross-sectional study assessed the frequency of IgG, IgM, and IgA ACA in type 2 diabetics with and without history of vascular events for the last 5 years, and in healthy controls. ACA were detected by enzyme immunoassay. A total of 73 type 2 diabetics (33 with history of vascular events) and 54 healthy controls were tested. Most diabetics were female (p = 0.003), and older than controls (p 0.09). ACA positivity rates were also similar when diabetics with and without history of vasculopathy were compared (p > 0.47). After adjusting for gender, age, hypertension, and smoking status, a weak but statistically insignificant association between IgM ACA and diabetics with vasculopathy was found (adjusted OR 2.7;95% CI 0.2 - 34.2;p = 0.441). Overall, levels of IgG (r = 0.25;p = 0.005) and IgM (r = 0.23;p = 0.010) ACA were associated with increasing age. In short, the frequency of a positive ACA test in type 2 diabetics (with or without previous macrovasculopathy) was not significant as compared to healthy controls. There was no association of ACA with vascular events in patients with type 2 diabetes.

利拉鲁肽对糖尿病合并心肌梗死小鼠心功能的影响及其作用机制

目的探讨利拉鲁肽对糖尿病合并心肌梗死小鼠心功能的影响及其作用机制。方法按随机数字表法将75只KM雄性小鼠分为对照组15只和模型处理组60只。对模型处理组的60只小鼠建立糖尿病小鼠模型,建模成功后再按随机数字表法选取模型处理组的45只小鼠建立糖尿病合并心肌梗死小鼠模型,剩余的15只小鼠作为假手术组,且仅对小鼠开胸而不结扎冠状动脉。将45只糖尿病合并心肌梗死小鼠模型按随机数字表法分为模型组(n=15)、心梗干预组(n=15)、糖干预组(n=15),给予心梗干预组小鼠灌胃硫酸氢氯吡格雷+阿托伐他汀钙片干预,给予糖干预组小鼠腹腔注射利拉鲁肽注射液干预,其余小鼠均不做特殊处理。干预7d后,使用心电图机观察各组小鼠的心电图,采用HE染色及2,3,5-氯化三苯四氮唑染色观察各组小鼠的病理情况及心肌梗死面积,采用Western blot检测各组小鼠心肌组织磷脂酰肌醇3-激酶(PI3K)、蛋白激酶B(AKT)、糖原合成酶激酶3β(GSK-3β)的蛋白表达量。结果(1)对照组、假手术组小鼠心电图无明显异常,模型组小鼠心电图存在明显的ST段抬高及变异T波,心梗干预组、糖干预组小鼠心电图ST段抬高及变异T波较模型组明显改善,且心梗干预组的改善效果优于糖干预组。(2)对照组、假手术组小鼠心肌纤维排列整齐紧凑,心肌细胞形态完整;相比于对照组、假手术组,模型组小鼠心肌组织可见梗死区,梗死周边区域心肌细胞形态不完整,排列混乱,有大量炎症细胞浸润和纤维组织增生;相比于模型组,心梗干预组和糖干预组小鼠上述病理改变程度均得到改善,心梗干预组改善程度优于糖干预组。(3)与对照组相比,假手术组小鼠心肌梗死区面积百分比无明显变化(P>0.05);与对照组和假手术组相比,模型组小鼠的心肌梗死区面积百分比明显增加(P<0.05);与模型组相比,心梗干预组与糖干预组小鼠的心肌梗死区面积百分比均减少(P<0.05),且心梗干预组小鼠的心肌梗死区面积百分比小于糖干预组,但差异无统计学意义(P>0.05)。(4)与对照组相比,假手术组小鼠心肌组织的PI3K、AKT和GSK-3β蛋白表达量升高,而模型组小鼠心肌组织的AKT蛋白表达量降低,GSK-3β蛋白表达量则升高(P<0.05),PI3K蛋白表达量的变化无统计学意义(P>0.05);与模型组相比,糖干预组小鼠心肌组织的PI3K、AKT和GSK-3β蛋白表达量升高,而心梗干预组小鼠心肌组织的PI3K、AKT蛋白表达量升高(P<0.05),但GSK-3β蛋白表达量变化无统计学意义(P>0.05);与心梗干预组小鼠相比,糖干预组小鼠心肌组织的AKT、GSK-3β蛋白表达量升高(P<0.05),而PI3K蛋白表达量的变化无统计学意义(P>0.05)。结论利拉鲁肽可改善糖尿病合并心肌梗死小鼠模型的心功能损伤、心肌梗死面积及心肌间质纤维化,其可能通过PI3K/AKT信号通路调节GSK-3β的表达而发挥作用。

预后营养指数与急性ST段抬高型心肌梗死合并2型糖尿病患者经皮冠状动脉介入术后院内主要不良心血管事件关系的研究

背景 近年来我国糖尿病和心血管疾病患病人数逐年增加,已有研究证明了糖尿病可扩大心血管疾病的不良影响,涉及营养和炎症途径。预后营养指数(PNI)是免疫营养的标志,可反映个体的炎症、免疫状态和营养状况。由于其简单、快速、易得和可靠等优点,近年来关于PNI在各系统中的研究越来越多,但少有文献探讨PNI在心血管疾病中的作用。目的 本研究旨在探讨PNI与急性ST段抬高型心肌梗死(STEMI)合并2型糖尿病(T2DM)患者经皮冠状动脉介入(PCI)术后发生院内主要不良心血管事件(MACE)的关系。方法 回顾性分析2015年1月—2023年6月在新疆医科大学第一附属医院1 053例行PCI术的STEMI合并T2DM患者的临床资料。收集患者资料,计算PNI,根据患者住院期间是否发生MACE,分为MACE组(177例)和非MACE组(876例)。同时依据PNI预测STEMI合并T2DM患者行PCI术后发生院内MACE的截断值将患者分为高PNI组(686例)与低PNI组(367例)。采用单因素及多因素Logistic回归分析探究STEMI合并T2DM患者行PCI后发生院内MACE的影响因素。绘制受试者工作特征(ROC)曲线探究PNI对STEMI合并T2DM患者行PCI术后发生院内MACE的预测价值,计算曲线下面积(AUC)。采用Pearson相关性分析或Spearman秩相关分析探究PNI与心血管疾病危险因素之间的相关性。结果MACE组和非MACE组性别、年龄、高血压病史、血清葡萄糖、Killip分级、乳酸脱氢酶、心率、肌红蛋白、肌酸激酶-MB同工酶(CK-MB)、白细胞计数、脑钠肽(BNP)、PNI、全球急性冠脉事件注册(GRACE)评分、血红蛋白、血小板计数、淋巴细胞计数、白蛋白、总蛋白、肌酐、尿素氮、三酰甘油比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,血清葡萄糖升高(OR=1.055,95%CI=1.002~1.112,P=0.044)、GRACE评分高(OR=1.034,95%CI=0.876~0.939,P<0.001)是STEMI合并T2DM患者行PCI术后发生院内MACE的危险因素,PNI升高(OR=0.907,95%CI=1.017~1.050,P<0.001)是患者行PCI术后发生院内MACE的保护因素。PNI预测STEMI合并T2DM患者行PCI术后发生院内MACE的AUC为0.734(95%CI=0.694~0.773),通过Logistic回归分析构建预测模型,模型预测STEMI合并T2DM患者行PCI术后发生院内MACE的AUC为0.791(95%CI=0.753~0.858)。低PNI组发生MACE、主动脉内球囊反搏比例、住院天数、血清葡萄糖、肌钙蛋白T、CK-MB、肌红蛋白、BNP、C反应蛋白、肌酐、尿素氮高于高PNI组,光学相干断层扫描技术比例、总胆固醇、三酰甘油、HDL-C、血红蛋白低于高PNI组(P<0.05)。相关性分析结果显示,PNI与血红蛋白、HDL-C、总胆固醇、三酰甘油呈正相关(P<0.05);PNI与血清葡萄糖、肌酐、尿素氮、BNP、肌钙蛋白T、CK-MB、肌红蛋白、C反应蛋白呈负相关(P<0.05)。结论 PNI是STEMI合并T2DM患者PCI术后院内发生MACE的独立预测因素,临床中可作为监控患者免疫营养状态且预测患者短期预后的辅助指标。