摘要
目的 探讨糖尿病和非糖尿病急性心肌梗死 (AMI)患者急性期血糖升高的特点、程度及其对心功能的影响。方法 收集我院 1999年 1月～ 2 0 0 3年 12月AMI患者 92例 ,其中 4 2例合并糖尿病 (糖尿病组 ) ,5 0例无糖尿病 (非糖尿病组 ) ,比较两组血糖变化特点及其对心功能的影响。结果 糖尿病组中 ,合并高血压、高血脂者显著多于非糖尿病组 ;AMI后空腹血糖 [(9.9± 2 .2 )mmol/L]高于非糖尿病组 [(5 .6± 2 .1)mmol/L ,P <0 .0 5 ],果糖胺 [(337± 4 6 ) μmol/L]亦高于非糖尿病组 [(2 2 6± 18) μmol/L ,P <0 .0 5 ]。糖尿病组中 ,86 %的患者空腹血糖高于正常 ;非糖尿病组中 ,18%的患者有应激性高血糖 ,血糖多为轻度升高 ,并在心肌梗死后 2 4～ 4 8h降为正常 ,血果糖胺水平正常 ;而糖尿病组的血糖下降缓慢。糖尿病组心肌肌酸激酶同工酶及肌钙蛋白T水平高于非糖尿病组 ,心功能则显著低于非糖尿病组。空腹血糖增高者的血糖与心功能成负相关 (r =- 0 .6 7,P <0 .0 5 )。AMI前未诊断为糖尿病者占糖尿病患者的 10 %。结论 糖尿病患者在AMI时多数伴有应激性血糖升高 ,其中 10 %为新诊断患者 ,非糖尿病患者发生应激性血糖升高的比例少。
Objective To appraise the characteristic of blood sugar changes in acute myocardial infarction (AMI) patients with or without diabetes mellitus and its relationship with heart function.Methods Compare the blood glucose changes in 42 AMI patients with diabetes and 50 AMI patients without diabetes and its influence on cardiac function.Results The AMI patients of diabetes group were more often accompanied by hyperlipidemia and hypertension than the group without diabetes. The blood glucose and the fructosamine were higher in AMI with diabetic group compared to that of without [(9.9±2.2) mmol/L vs (5.6±2.1) mmol/L,P<0.05;(337±46) vs (226±18) μmol/L, P<0.05]. In diabetic group, 86% patients had fasting blood glucose higher than normal, whereas in the group without diabetes only 18% had blood glucose higher than normal. The elevated blood glucose levels in the non-diabetic group were of mild degree and returned to normal in 24 to 48 hours, faster than that in the diabetic group. The fructosamine levels in the non-diabetic group were normal. Comparing to the non-diabetic group, the creatine phosphokinase and troponin T levels were higher, the heart function decreased much more in the diabetic group. In patients with blood glucose higher than normal, the blood glucose was negatively correlated with heart function(r= -0.67, P<0.05). About 10% diabetic patients newly diagnosed had elevated blood fructosamine.Conclusion Blood glucose usually rises in AMI patients with diabetes and 10% are newly diagnosed patients. About 18% non-diabetics have blood glucose level higher than normal. To distinguish the two kinds of patients is very important, for AMI patients with diabetes mellitus usually have worser heart functions.
出处
《上海医学》
CAS
CSCD
北大核心
2004年第7期460-461,共2页
Shanghai Medical Journal
