急性心肌梗死后侧支循环的形成及糖尿病对其影响

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1996年12月－1999年12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210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（162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11例非糖尿病AMI患者中只有2例可侧支循环（18．2％），而无室壁瘤形成的87例非糖尿病AMI患者中83例可侧支循环（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例可侧支循环（18．8％）；而162例非糖尿病患者侧支循环计分平均2．42，140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。室壁瘤患者很少形成侧支循环，糖尿病影响侧支循环的建立。

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

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