糖尿病对急性心肌梗死缺血预适应的影响

目的研究急性心肌梗死(AMI)合并糖尿病(DM)的缺血预适应(IP)效应.方法选择AMI合并2型DM患者(DM组)117例,同期无糖尿病AMI患者(非DM组)412例.按AMI前24 h有无梗死前心绞痛发作分为AP(+)组及AP(-)组,分别分析其冠心病危险因素、AMI并发症及心源性住院病死率等指标.结果非DM组中AP(+)组的CK-MB峰值、室速及心力衰竭发生率以及心源性住院病死率均明显低于AP(-)组,出院时LVEF明显高于AP(-)组(P＜0.05);DM组中AP(+)组及AP(-)组上述各项指标均无显著性差异.结论梗死前心绞痛对于无糖尿病的AMI病人具有心脏保护作用,而这一缺血预适应效应在糖尿病患者中丧失.

The Effect of Diabetes on Ischemic Preconditioning in Patients with Acute Myocardial Infarction

Objective:To study ischemic preconditioning in diabetic patients with acute myocardial infarction(AMI).Methods:One hundred and seventeen patients with type2diabetes and AMI(DM group)were divided into two groups which included AP(+)and AP(-)according to the presence and absence of pre-infarction angina episodes occurring within24h before the onset of AMI.Four hundred and twelve patients with non-diabetes and AMI(non-DM group)were also studied.The risk factors of coronary heart disease,the complication of AMI,and in-hospital cardiogenic mortality were analyzed.Results:In non-DM group,the peak of CK-MB value,incidence of ventricular tachycardia,heart failure,and cardiogenic mortality were lower in AP(+)subgroup compared with that in AP(-)subgroup,and pre-discharge LVEF was higher in AP(+)subgroup compared with that in AP(-)subgroup.Conclusion:Pre-infarction angina has a cardiac protective effect in non-diabetic patients with AMI,and the ischemic pre-conditioning effect is lost in diabetic patients with AMI.