中国心血管杂志
中國心血管雜誌
중국심혈관잡지
CHINESE JOURNAL OF CARDIOVASOLOGY
2014年
4期
264-268
,共5页
脂联素%急性心肌梗死%糖代谢异常
脂聯素%急性心肌梗死%糖代謝異常
지련소%급성심기경사%당대사이상
Adiponectin%Acute myocardial infarction%Abnormal glycometabolism
目的：了解急性心肌梗死患者的糖代谢状态,观察糖代谢异常急性心肌梗死患者行急诊经皮冠状动脉介入治疗后脂联素水平的变化。方法连续入选2010年7月至2011年9月首都医科大学附属北京友谊医院心血管中心住院治疗的首次急性心肌梗死患者共206例。对无糖尿病病史的患者住院期间行口服葡萄糖耐量试验,根据检查结果及既往有无糖尿病病史分为正常糖耐量、糖调节受损与糖尿病3组。分别于PCI手术前后、发病24、48、72 h、7 d检测脂联素水平,观察其变化趋势。结果(1)58例(28.2%)患者入院前已确诊为2型糖尿病,无糖尿病病史的患者中46.6%的患者为糖调节异常,10.8%新诊断为2型糖尿病,全部病例中69.4%的患者合并糖代谢异常。(2)糖代谢异常组患者的即刻血糖[(11.50±4.40)mmol/L、(8.22±1.38)mmol/L比(6.42±0.86)mmol/L]、空腹血糖水平[(9.23±4.11)mmol/L、(6.37±1.81)mmol/L比(5.19±0.79)mmol/L]均显著高于正常糖耐量组(均为P﹤0.05)；糖尿病组的左心室射血分数明显低于其他两组(51.82%±7.02%比54.70%±7.98%、54.75%±7.72%,均为P﹤0.05)；糖尿病组在PCI手术前后、发病后48、72 h与7 d脂联素水平均较正常糖耐量组低[(13.42±1.73)μg/ml比(15.37±1.73)μg/ml、(12.92±2.45)μg/ml比(14.71±1.61)μg/ml、(11.32±3.37)μg/ml比(12.48±2.64)μg/ml、(11.55±3.05)μg/ml比(13.13±2.55)μg/ml、(11.89±2.92)μg/ml比(13.56±2.36)μg/ml,均为P﹤0.05],糖尿病组在PCI手术前后、发病后72 h与7 d脂联素水平均低于糖调节受损组[(13.42±1.73)μg/ml比(15.61±1.60)μg/ml、(12.92±2.45)μg/ml 比(14.76±1.65)μg/ml、(11.55±3.05)μg/ml 比(12.61±2.13)μg/ml、(11.89±2.92)μg/ml比(13.18±2.04)μg/ml,均为P﹤0.05]；各组PCI术后脂联素水平均较术前降低(均为P﹤0.05)。结论糖尿病的急性心肌梗死患者脂联素水平低于正常糖耐量组和糖调节受损组的患者；正常糖耐量组、糖调节受损组及糖尿病组PCI术后脂联素水平均较术前显著降低,于发病后24 h各组脂联素水平降至最低值,随后逐渐回升。
目的：瞭解急性心肌梗死患者的糖代謝狀態,觀察糖代謝異常急性心肌梗死患者行急診經皮冠狀動脈介入治療後脂聯素水平的變化。方法連續入選2010年7月至2011年9月首都醫科大學附屬北京友誼醫院心血管中心住院治療的首次急性心肌梗死患者共206例。對無糖尿病病史的患者住院期間行口服葡萄糖耐量試驗,根據檢查結果及既往有無糖尿病病史分為正常糖耐量、糖調節受損與糖尿病3組。分彆于PCI手術前後、髮病24、48、72 h、7 d檢測脂聯素水平,觀察其變化趨勢。結果(1)58例(28.2%)患者入院前已確診為2型糖尿病,無糖尿病病史的患者中46.6%的患者為糖調節異常,10.8%新診斷為2型糖尿病,全部病例中69.4%的患者閤併糖代謝異常。(2)糖代謝異常組患者的即刻血糖[(11.50±4.40)mmol/L、(8.22±1.38)mmol/L比(6.42±0.86)mmol/L]、空腹血糖水平[(9.23±4.11)mmol/L、(6.37±1.81)mmol/L比(5.19±0.79)mmol/L]均顯著高于正常糖耐量組(均為P﹤0.05)；糖尿病組的左心室射血分數明顯低于其他兩組(51.82%±7.02%比54.70%±7.98%、54.75%±7.72%,均為P﹤0.05)；糖尿病組在PCI手術前後、髮病後48、72 h與7 d脂聯素水平均較正常糖耐量組低[(13.42±1.73)μg/ml比(15.37±1.73)μg/ml、(12.92±2.45)μg/ml比(14.71±1.61)μg/ml、(11.32±3.37)μg/ml比(12.48±2.64)μg/ml、(11.55±3.05)μg/ml比(13.13±2.55)μg/ml、(11.89±2.92)μg/ml比(13.56±2.36)μg/ml,均為P﹤0.05],糖尿病組在PCI手術前後、髮病後72 h與7 d脂聯素水平均低于糖調節受損組[(13.42±1.73)μg/ml比(15.61±1.60)μg/ml、(12.92±2.45)μg/ml 比(14.76±1.65)μg/ml、(11.55±3.05)μg/ml 比(12.61±2.13)μg/ml、(11.89±2.92)μg/ml比(13.18±2.04)μg/ml,均為P﹤0.05]；各組PCI術後脂聯素水平均較術前降低(均為P﹤0.05)。結論糖尿病的急性心肌梗死患者脂聯素水平低于正常糖耐量組和糖調節受損組的患者；正常糖耐量組、糖調節受損組及糖尿病組PCI術後脂聯素水平均較術前顯著降低,于髮病後24 h各組脂聯素水平降至最低值,隨後逐漸迴升。
목적：료해급성심기경사환자적당대사상태,관찰당대사이상급성심기경사환자행급진경피관상동맥개입치료후지련소수평적변화。방법련속입선2010년7월지2011년9월수도의과대학부속북경우의의원심혈관중심주원치료적수차급성심기경사환자공206례。대무당뇨병병사적환자주원기간행구복포도당내량시험,근거검사결과급기왕유무당뇨병병사분위정상당내량、당조절수손여당뇨병3조。분별우PCI수술전후、발병24、48、72 h、7 d검측지련소수평,관찰기변화추세。결과(1)58례(28.2%)환자입원전이학진위2형당뇨병,무당뇨병병사적환자중46.6%적환자위당조절이상,10.8%신진단위2형당뇨병,전부병례중69.4%적환자합병당대사이상。(2)당대사이상조환자적즉각혈당[(11.50±4.40)mmol/L、(8.22±1.38)mmol/L비(6.42±0.86)mmol/L]、공복혈당수평[(9.23±4.11)mmol/L、(6.37±1.81)mmol/L비(5.19±0.79)mmol/L]균현저고우정상당내량조(균위P﹤0.05)；당뇨병조적좌심실사혈분수명현저우기타량조(51.82%±7.02%비54.70%±7.98%、54.75%±7.72%,균위P﹤0.05)；당뇨병조재PCI수술전후、발병후48、72 h여7 d지련소수평균교정상당내량조저[(13.42±1.73)μg/ml비(15.37±1.73)μg/ml、(12.92±2.45)μg/ml비(14.71±1.61)μg/ml、(11.32±3.37)μg/ml비(12.48±2.64)μg/ml、(11.55±3.05)μg/ml비(13.13±2.55)μg/ml、(11.89±2.92)μg/ml비(13.56±2.36)μg/ml,균위P﹤0.05],당뇨병조재PCI수술전후、발병후72 h여7 d지련소수평균저우당조절수손조[(13.42±1.73)μg/ml비(15.61±1.60)μg/ml、(12.92±2.45)μg/ml 비(14.76±1.65)μg/ml、(11.55±3.05)μg/ml 비(12.61±2.13)μg/ml、(11.89±2.92)μg/ml비(13.18±2.04)μg/ml,균위P﹤0.05]；각조PCI술후지련소수평균교술전강저(균위P﹤0.05)。결론당뇨병적급성심기경사환자지련소수평저우정상당내량조화당조절수손조적환자；정상당내량조、당조절수손조급당뇨병조PCI술후지련소수평균교술전현저강저,우발병후24 h각조지련소수평강지최저치,수후축점회승。
Objective To characterize the glucometabolic state of patients with acute myocardial infarction ( AMI) ,and to investigate the influence of abnormal glycometabolism on adiponectin levels after the first acute myocardial infarction treated with primary percutaneuos coronary intervention. Methods Two hundred and six consecutive patients with ST-elevated myocardial infarction ( STEMI) in Beijing Friendship hospital were enrolled from July 2010 to August 2011. Patients with non-diagnosed diabetes were performed oral glucose tolerance test ( OGTT ) . Patients with AMI were divided into three groups according to glucometabolic state:NGT( normal glucose tolerance) , IGR( impaired glucose regulation) and DM( Diabetes Mellitus) . Blood samples were drawn before the invasive procedure, immediately after the invasive procedure, and at 24, 48, 72 h and 7days after AMI onset. Left ventricular end-diastolic diameter ( LVEDD ) and left ventricular ejection fraction ( LVEF ) were measured in all patients. Results ( 1 ) 28. 2% patients had known type 2 diabetes mellitus before AMI. Of patients with no diabetes, 46. 6% had impaired glucose regulation ( IGR) and 10. 8% had newly diagnosed diabetes. Of all patients with AMI, 79. 4% had abnormal glycometabolism. (2) Compared with NGT and IGT group, the fasting blood glucose [(9. 23 ± 4. 11)mmol/L,(6. 37 ± 1. 81) mmol/L vs. (5. 19 ± 0. 79) mmol/L, all P ﹤0. 05] and blood glucose immediately (11. 50 ± 4. 40,8. 22 ± 1. 38 vs. 6. 42 ± 0. 86,all P﹤0. 05) at admission in DM group were significantly higher. LVEF of DM group was significantly lower than other groups ( 51. 82% ± 7. 02%vs. 54. 70% ± 7. 98%,54. 75% ± 7. 72%,all P﹤0. 05). Plasma adiponectin level in DM group before the invasive procedure, immediately after the invasive procedure, and at 48, 72 h and 7 days after AMI onset were lower than NGT group [(13. 42 ± 1. 73) μg/ml vs. (15. 37 ± 1. 73) μg/ml,(12. 92 ± 2. 45) μg/ml vs. (14. 71 ± 1. 61) μg/ml,(11. 32 ± 3. 37) μg/ml vs. (12. 48 ± 2. 64) μg/ml,(11. 55 ± 3. 05) μg/ml vs. (13. 13 ± 2. 55) μg/ml,(11. 89 ± 2. 92) μg/ml vs. (13. 56 ± 2. 36) μg/ml,all P﹤0. 05]. Plasma adiponectin level in DM group before the invasive procedure, immediately after the invasive procedure and 72 h and 7 days after AMI onset were lower than in IGT group[(13. 42 ± 1. 73) μg/ml vs. (15. 61 ± 1. 60)μg/ml,(12. 92 ± 2. 45) μg/ml vs. (14. 76 ± 1. 65) μg/ml,(11. 55 ± 3. 05) μg/ml vs. (12. 61 ± 2. 13)μg/ml,(11. 89 ± 2. 92) μg/ml vs. (13. 18 ± 2. 04) μg/ml,all P﹤0. 05]. Conclusions Compared with NGT and IGR groups, adiponectin in DM group is significantly lower. Plasma adiponectin levels after the invasive procedure in NGT, IGR and DM groups are significantly lower than before the invasive procedure. Plasma adiponectin is decreased to the lowest level at 24 h after AMI onset in NGT, IGR and DM patients.
