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Effects of preinfarction angina on diabetic patients with acute myocardial infarction 梗死前心绞痛对糖尿病合并急性心肌梗死的影响
Pub Date : 2008-04-01 DOI: 10.3760/CMA.J.ISSN.1008-6315.2008.04.008
Rong-ying Wang
Objective To evaluate the effects of preinfarction angina on diabetic patients with acute myocardial infarction(AMI)and its mechanism.Method 216 diabetic patients with AMI were divided into two groups:no previous angina(group A,n=78);preinfarction anginao ccurring within 48h before onset of AMI(group B,n=138).All patients underwent thrombolysis or direct PCI within 6h after onset of AMI;Plasma necrosis inflammation markers were continuously meastlred;99mTc gated cardiac blood pool image was performed to measure ventricular function at 2 weeks.The incidence of arrythmia,heart failure,cardiogenic shock,and mortality in hospital stay wa8 observed.Results ①The peak of creatine MB fraction(CK-MB),brain natriuretic peptide,cardiac troDoRin Ⅰ,and intedeukin-8 was signilicantly lower in group B than that of group A(P<0.05).②Left ventricular systolic perfornlance parameters including LVEF,LPER and LTPER were better in group B than those in group A(P<0.05);Left ventficular diastolic performance parameters including LPFR and LTPFR were also better in group B than that in group A(P<0.05).③The incidence of arrythmia,heart failure or cardiogenic shock,and mortality was lower in group B than that in group A(P<0.05).Conclusion Preinfaretion angina has cardioprotective effects in diabetic patients,including limiting infarct area,protecting ventricular function and improving prognosis,the mechnism of which could be that preinfarction angina inhabits overactivating of nerve endocrine hormone and cytokine. Key words: Angina pectoris;  Acute myocardial infarction;  Diabetes;  Cardiac function
目的探讨梗死前心绞痛对糖尿病合并急性心肌梗死(AMI)患者的影响及其机制。方法216例合并AMI的糖尿病患者分为无心绞痛史(A组,n=78)和梗死前48h内心绞痛史(B组,n=138)。所有患者在AMI发病后6h内均行溶栓或直接PCI治疗;持续测量血浆坏死炎症标志物;2周时行99mTc门控心脏血池图像测量心室功能。观察心律失常、心力衰竭、心源性休克的发生率及住院期间的死亡率。结果①B组大鼠肌酸MB分数(CK-MB)、脑利钠肽、心肌肽肽Ⅰ、白细胞介素-8峰值均显著低于A组(P<0.05);②B组左室收缩性能参数LVEF、LPER、LTPER均优于A组(P<0.05),左室舒张性能参数LPFR、LTPFR均优于A组(P<0.05)。③B组心律失常、心力衰竭、心源性休克发生率及病死率均低于A组(P<0.05)。结论梗死前心绞痛对糖尿病患者具有限制梗死面积、保护心室功能、改善预后的心脏保护作用,其机制可能与心肌梗死前心绞痛与神经内分泌激素和细胞因子的过度激活有关。关键词:心绞痛;急性心肌梗死;糖尿病;心脏功能
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中国老年学杂志
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