胰岛素强化治疗对急性心肌梗死合并糖尿病患者的预后影响和临床评价

目的探讨胰岛素强化治疗对急性心肌梗死合并糖尿病患者的临床疗效和安全性。方法将176例患者随机分为胰岛素强化治疗组92例和对照组84例．在给予心肌梗死治疗的基础上，治疗组空腹血糖控制在（4．4～6．1）mmol／L，对照组的空腹血糖控制在（6．1～10．0）mmol／L，比较两组的血糖、餐后2h血糖、同型半胱氨酸（Hcy）、胆固醇、甘油三酯、低密度脂蛋白（LDL—C）和高密度脂蛋白（HDL—C）的水平。结果经过1个疗程（7d）治疗后，强化治疗组的空腹血糖浓度、餐后2h血糖浓度和日需胰岛素用量显著低于对照组（P〈0．05），治疗组的Hcy、胆固醇、甘油三酯和LDL—C显著降低，与血糖水平呈显著正相关，HDL—C水平显著增加，与血糖水平呈显著负相关。治疗组的并发症发生率和病死率远低于对照组（P〈0．05）。结论胰岛素强化治疗可以改善急性心肌梗死合并糖尿病患者的预后，安全性好，值得临床推广使用。

Prognosis effect and clinical evaluatin of intensive insulin therapy on a- cute myocardial infarction patients with diabetes mellitus

Objective To explore the clinical effects and safety of intensive insulin therapy on acute myocardial in- farction patients with diabetes mellitus. Methods A total of 176 patients were divided into intensive insulin therapy group with 92 cases and control group with 84 cases randomly. On the basis of the treatment for acute myocardial in- farction, the fasting blood glucose levels of the therapy group and control group were maintained at （4.4-6.1） mmol/L and （6.1-10.0） mmol/L, respectively. The levels of indexes including fasting blood glucose, 2 h postprandial blood glucose, Hcy, cholesterol, glycerin trilaurate, LDL-C and HDL-C were compared. Results After seven days therapy, the fasting blood glucose levels, 2 h postprandial blood glucose levels and consumptions of insulin per day of control group were significantly higher than the therapy group （P〈0.05）. The levels of homocysteine （Hey）, cholesterol, triglyc- eride and low-density lipoprotein-cholesterol （LDL-C） were decreased and positively correlated to the blood glucose, while the level of how-density lipoprotein-cholesterol （HDL-C） were increased and negatively correlated to the blood glucose. The rates of complications and mortality for therapy group were significantly lower than the control group （P〈 0.05）. Conclusion Intensive insulin therapy can improve the prognosis of acute myocardial infarction patients with dia- betes mellitus and it＇s worthy to be widely spread in clinical condition.