缺血预适应在合并急性前壁心肌梗死的糖尿病患者中的临床研究

目的探讨缺血预适应(ischemic preconditioning,IP)对合并急性前壁心肌梗死的糖尿病患者梗死面积和左室功能的近期影响。方法114例行急诊冠状动脉造影示梗死相关动脉为前降支近段病变并进行成功经皮冠状动脉成形术(PCI)术的首次急性前壁心肌梗死患者,其中有63例合并有糖尿病,分组比较IP对肌酸激酶(CK)及肌酸激酶同工酶(CK-MB)峰值浓度和左室功能的影响。共分为4组:非糖尿病IP组23例(A组);非糖尿病非IP组28例(B组);糖尿病IP组28例(C组);糖尿病非IP组(D组)35例。结果CK、CK-MB的峰值浓度A组显著低于B组(P<0.01),左室射血分数值A组显著高于B组(P<0.01)。C组与D组比较各项指标差异均无统计学意义(均P>0.05)。结论IP在无糖尿病的急性前壁心肌梗死患者中可能有助于限制梗死面积,保护左室功能,而在合并糖尿病的急性前壁心肌梗死患者中,未观察到上述心脏保护作用。

Cinical study on effects of ischemic preconditioning in diabetic patients with acute anterior myocardial infarction

Objective To investigate short-term effects of ischemic preconditioning(IP) on left ventricular function and infarction size in diabetic patients with acute anterior myocardial infarction.Methods The study enrolled 114 patients with first acute anterior myocardial infarction of the proximal left anterior descending artery who underwent successful direct percutaneous coronary intervention(PCI).Among them,51 patients without diabetes were divided into group A(with IP) and group B(without IP),another 63 cases with diabetes were divided into group C(with IP) and group D(without IP).The effects of IP on peak creatine kinase(CK) value,CK isoenzyme(CK-MB),and left ventricular function were analyzed separately.Results The peak values CK of and CK-MB were significantly lower in group A than those in group B(P<0.01).Meanwhile,the left ventricular ejection fraction was significantly higher in group A than that in group B(P<0.01),while there were no significant differences in various items between group C and group D(all P>0.05).Conclusion IP could limit infarction size,protect the left ventricular function in non-diabetic patients with acute anterior myocardial infarction.However,such beneficial effects of IP are not observed in the diabetic patients.