中青年2型糖尿病患者合并心肌梗死的窦性心率震荡分析

目的探讨中青年2型糖尿病患者合并急性心肌梗死时窦性心率震荡（heart rate turbulence，HRT）的可能变化及其临床意义。方法选择中青年合并心肌梗死的2型糖尿病患者36例（A组）、单纯心梗患者36例（B组）、单纯2型糖尿病患者36例（C组）和对照组36例（D组）作为研究对象。4组均行24h动态心电图检查，分析单次室性期前收缩后HRT的初始值（Turbulence Onset，TO）、斜率（Turbulence Slope，TS）以及TO和Ts异常的发生率。结果A、B、C组TO、TS值明显异常，与D组比较均有显著性差异（P〈0．01），A、B组的TO、TS值与C组比较均有显著性差异（P〈0．01），A组与B组比较差异亦有显著性（P〈0．05，P〈0．01）。四组TO及Ts异常发生率分别为A组（61．1％、66．7％）、B组（50％、55．6％）、C组（36．1％、38．9％）和D组（8．3％、5．6％），A、B、C组T0、TS值异常率较D组明显升高，差异有显著性意义（P〈0．01），A、B组TO、TS值异常率较c组明显升高，A组TO、TS值异常发生率增高最明显。结论青中年糖尿病合并心肌梗死患者HRT现象明显减弱，同时HRT异常率增高较明显。HRT可作为临床上青中年糖尿病合并心肌梗死患者预后判断的重要指标。

Heart rate turbulence in middle-young diabetic patients with acute myocardial infarction

Objective To observe the change of heart rate turbulence(HRT) and its clinic significance in diabetic patients with acute myocardial infarction(AMI).Methods Patients were divided into 4 groups:36 patients with diabetes and AMI in group A,36 patients with AMI in group B,36 patients with diabetes in group C and 36 healthy subjects controls in group D.All patients and subjects were examined by 24-hour holter monitoring,Turbulence Onset(TO) and Turbulence Slope (TS) after single premature ventricular systole(PVS) were calculated from Holter records and the abnormal incidence of TO and TS were compared in four groups.Results The values of TO,TS in group A,B and C were significantly different from those in group D(P<0.01);the values of TO, TS in group A and B were significantly different from those in group C(P<0.01);the values of TO, TS in group A were significant different from those in group B(P<0.05,P<0.01,respectively). The abnormal incidences of TO,TS in four groups were 61.1%and 66.7%(group A),50%and 55.6%(group B),36.1%and 38.9%(group C) and 8.3%and 5.6%(group D),respectively.The abnormal incidences of TO,TS in group A,B and C have a significant difference compared with those of group D(P<0.01),the abnormal incidences of TO,TS in A and B groups were significantly different from those in group C(P<0.01),and the abnormal incidences of TO,TS in group A were the highest of the four groups.Conclusion The reduction and the abnormal incidence of HRT in middle-young diabetic patients with acute myocardial infarction are more obvious than in the patients with acute myocardial infarction or diabetes alone.HRT may become an important clinic index in predicting the prognosis of diabetic patients with acute myocardial infarction.