中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2011年
2期
120-124
,共5页
刘挺松%陈一天%江时森%宫剑滨%张启高%彭永平%王立军%程训民%邹莺
劉挺鬆%陳一天%江時森%宮劍濱%張啟高%彭永平%王立軍%程訓民%鄒鶯
류정송%진일천%강시삼%궁검빈%장계고%팽영평%왕립군%정훈민%추앵
急性心肌梗死%高血糖%动态血糖监测%超声心动图%心功能不全
急性心肌梗死%高血糖%動態血糖鑑測%超聲心動圖%心功能不全
급성심기경사%고혈당%동태혈당감측%초성심동도%심공능불전
Acute myocardial infarction%Hyperglycemia%Continuous glucose monitoring%Echocardiography%Cardiac dysfunction
目的 探讨急性心肌梗死早期不同糖代谢状态患者心功能损害及恢复的差异.方法 对连续111例既往无糖尿病史的急性心肌梗死患者进行动态血糖监测,评估不同糖代谢状态患者入院心功能状态和超声心动图指标以及3个月后心功能状态和超声心动图指标的差异.结果 与血糖正常组及一过性血糖升高组相比,持续性血糖升高患者入院心功能Killip Ⅱ级及以上比例显著升高[分别为13.3%(4/30)、33.3%(12/36)、55.6%(25/45),20.0%(6/30)、41.7%(15/36)、93.3%(42/45),P均＜0.01)],院内超声心动图指标左心室射分数(LVEF)、二尖瓣舒张早期血流峰速度(E)及其与舒张晚期血流峰速度(A)的比值(E/A)显著下降[LVEF分别为0.52±0.02、0.48±0.01、0.37±0.02,E分别为(0.65±0.41)、(0.55±0.02)、(0.39±0.12)m/s,E/A分别为1.15±0.08、1.02±0.06、0.61±0.02,P均＜0.01)],左心室收缩末期容积(LVESV)、左室室壁节段运动积分指数(WMSI)显著增加[LVESV分别为(25.83±0.51)、(31.26±1.23)、(37.72±1.01)ml],WMSI分别为[1.5±0.3、1.8±0.2、2.6±0.4,P均＜0.01];心肌梗死后3个月,持续性血糖升高组较血糖正常组及一过性血糖升高组患者心功能NYHAⅡ级及以上比例显著升高[分别为67.5%(27/40),10.0%(3/30),11.8%(4/34),P＜0.01].3组患者超声心动图指标均较住院期间有所恢复,但持续性血糖升高患者改善较少.结论 急性心肌梗死早期血糖持续升高的患者心功能受损严重,且难以恢复.
目的 探討急性心肌梗死早期不同糖代謝狀態患者心功能損害及恢複的差異.方法 對連續111例既往無糖尿病史的急性心肌梗死患者進行動態血糖鑑測,評估不同糖代謝狀態患者入院心功能狀態和超聲心動圖指標以及3箇月後心功能狀態和超聲心動圖指標的差異.結果 與血糖正常組及一過性血糖升高組相比,持續性血糖升高患者入院心功能Killip Ⅱ級及以上比例顯著升高[分彆為13.3%(4/30)、33.3%(12/36)、55.6%(25/45),20.0%(6/30)、41.7%(15/36)、93.3%(42/45),P均＜0.01)],院內超聲心動圖指標左心室射分數(LVEF)、二尖瓣舒張早期血流峰速度(E)及其與舒張晚期血流峰速度(A)的比值(E/A)顯著下降[LVEF分彆為0.52±0.02、0.48±0.01、0.37±0.02,E分彆為(0.65±0.41)、(0.55±0.02)、(0.39±0.12)m/s,E/A分彆為1.15±0.08、1.02±0.06、0.61±0.02,P均＜0.01)],左心室收縮末期容積(LVESV)、左室室壁節段運動積分指數(WMSI)顯著增加[LVESV分彆為(25.83±0.51)、(31.26±1.23)、(37.72±1.01)ml],WMSI分彆為[1.5±0.3、1.8±0.2、2.6±0.4,P均＜0.01];心肌梗死後3箇月,持續性血糖升高組較血糖正常組及一過性血糖升高組患者心功能NYHAⅡ級及以上比例顯著升高[分彆為67.5%(27/40),10.0%(3/30),11.8%(4/34),P＜0.01].3組患者超聲心動圖指標均較住院期間有所恢複,但持續性血糖升高患者改善較少.結論 急性心肌梗死早期血糖持續升高的患者心功能受損嚴重,且難以恢複.
목적 탐토급성심기경사조기불동당대사상태환자심공능손해급회복적차이.방법 대련속111례기왕무당뇨병사적급성심기경사환자진행동태혈당감측,평고불동당대사상태환자입원심공능상태화초성심동도지표이급3개월후심공능상태화초성심동도지표적차이.결과 여혈당정상조급일과성혈당승고조상비,지속성혈당승고환자입원심공능Killip Ⅱ급급이상비례현저승고[분별위13.3%(4/30)、33.3%(12/36)、55.6%(25/45),20.0%(6/30)、41.7%(15/36)、93.3%(42/45),P균＜0.01)],원내초성심동도지표좌심실사분수(LVEF)、이첨판서장조기혈류봉속도(E)급기여서장만기혈류봉속도(A)적비치(E/A)현저하강[LVEF분별위0.52±0.02、0.48±0.01、0.37±0.02,E분별위(0.65±0.41)、(0.55±0.02)、(0.39±0.12)m/s,E/A분별위1.15±0.08、1.02±0.06、0.61±0.02,P균＜0.01)],좌심실수축말기용적(LVESV)、좌실실벽절단운동적분지수(WMSI)현저증가[LVESV분별위(25.83±0.51)、(31.26±1.23)、(37.72±1.01)ml],WMSI분별위[1.5±0.3、1.8±0.2、2.6±0.4,P균＜0.01];심기경사후3개월,지속성혈당승고조교혈당정상조급일과성혈당승고조환자심공능NYHAⅡ급급이상비례현저승고[분별위67.5%(27/40),10.0%(3/30),11.8%(4/34),P＜0.01].3조환자초성심동도지표균교주원기간유소회복,단지속성혈당승고환자개선교소.결론 급성심기경사조기혈당지속승고적환자심공능수손엄중,차난이회복.
Objective To explore the disparity of severity of cardiac dysfunction and recovery among different glycometabolic patients in the early phase of acute myocardial infarction (AMI) . Methods Consecutive 111 AMI patients without known diabetes underwent continuous glucose monitoring. Patients with different glycometabolic status were compared in terms of cadiac dysfunction and recovery at admission and 3month follow up. Results Compared to patients with normglycemia and transient hyperglycemia, patitents with persistent hyperglycemia were more likely to grade Killip Ⅱ or above,which were 13.3% (4/30) ,33. 3% ( 12/36) ,55. 6% (25/45), 20. 0% ( 6/30), 41.7% ( 15/36 ) and 93.3% (42/45) ( Ps ＜ 0. 01 ). In-hospital left ventricular ejection fraction (LVEF), mitral valve protodiastolic E peak velocities (E) and its ratio to late diastolic (E/A) decreased significantly ( LVEF :0. 52 ± 0. 02,0. 48 ± 0. 01 and 0. 37 ± 0. 02; E: [0. 65 ± 0. 41]m/s,[0.55 ± 0.02] m/s and [0.39 ±0. 12]m/s;E/A:1. 15 ±0.08,1.02 ±0.06 and 0.61 ±0.02,respectively) ( Ps ＜ 0. 01 ), whereas LVESV and WMSI increased significantly ( LVESV: [25.83 ± 0. 51] ml,[31.26 ± 1.23] ml, [37, 72 ± 1.01] ml; WMSI: 1.5 ± 0. 3,1.8 ± 0. 2 and 2. 6 ± 0. 4, respectively) ( Ps ＜ 0. 01 )There months after AMI,patitents with persistent hyperglycemia were more likely to grade NYHA Ⅱ or above compared to patients with normglycemia and transient hyperglycemia [67.5% (27/40), 10.0% (3/30) and 11.8% (4/34),respectively] (P ＜0. 01 ). Echocardiographic recovery was observed in each group,but less in persistent hyperglycemia patients. Conclusion Cardiac function of patients with persistent hyperglycemia suffered more severely from AMI and difficult to recover.
