摘要
目的评估强化降糖治疗对急性心肌梗塞（AMI）合并Ⅱ型糖尿病（DM）患者改善心功能及预后的价值,并探讨其可能机制。方法将40例AMI合并Ⅱ型糖尿病患者随机分为强化治疗组及常规治疗组,两组均根据中国急性心肌梗塞治疗指南予以正规药物治疗,强化降糖治疗组血糖控制在4.4-7.0mmol/L,常规治疗组血糖控制在7.0-11.1mmol/L。所有患者均监测治疗前后的血糖、糖化血红蛋白（HbA1c）、高敏C反应蛋白（HSCRP）、B型脑钠肽（BNP）、心功能（EF%）、左室舒张末期内径（LVEDD）、左室后壁舒张末期厚度（LVPWT）、室间膈厚度（IVST）、计算出左心室重量指数（LVMI）、颈动脉内中膜厚度（IMT）、颈动脉内径（R）、颈动脉内中膜厚度/血管内径（IMT/R）等参数的变化,使用EpiData（中文版）进行数据管理并做统计学分析。结果两组患者治疗后各项指标均有明显差异（均P〈0.05）,而强化组各项指标改善情况明显优于常规治疗组（P〈0.05）。其中HbA1c与HSCRP、BNP、LVMI及IMT/R成正相关,与心功能（EF%）成负相关。HSCRP与EF%成负相关,与IMT/R成正相关。结论强化降糖治疗可明显改善AMI合并Ⅱ型糖尿病患者的血管及心室重构,从而改善心功能,延长病人生存期,其机制可能与降低AMI的炎性介质有关。
Objective To study the value of Intensive hypoglycemic therapies to prolong life of acute myocardial infarction complicated with type 2diabetes.Methods 40 patients with acute myocardial infarction combined with type 2diabetes were randomly divided into intensive treatment group and conventional treatment group.Both groups,according to the acute myocardial infarction treatment guidelines,were treated with regular medication.The blood sugar of intensive treatment group and conventional treatment group were controlled to 4.4-7.0 mmol/L and 7.0-11.1mmol/L.The blood sugar,glycosylated hemoglobin（HbA1c）,high-sensitivity c-reactive protein（HSCRP）,b-type brain natriuretic peptide（BNP）and cardiac function（EF%）,left ventricular end-diastolic diameter（LVEDD）,left ventricular posterior wall thickness（LVPWT）,end-diastolic ventricular septal thickness（IVST）,calculate the left ventricular mass index（LVMI）,carotid intima-media thickness（IMT）,carotid artery diameter（R）and carotid intima-media thickness/parameters such as blood vessel diameter（IMT/R）were observed before and after treatment.Results The indicators of the two groups after treatment had obvious difference（P〈0.05）.The indicators in the intensified dose group was superior to conventional treatment group（P〈0.05）.Glycated hemoglobin（HbA1c）,high-sensitivity c-reactive protein（HSCRP）,b-type brain natriuretic peptide（BNP）and left ventricular mass index（LVMI）,carotid intima-media thickness were positive related to vascular diameter（IMT/R）,and negative to cardiac function（EF %）correlation.HSCRP was negative correlation to EF % and positively related to IMT/R.Conclusion Strengthening hypoglycemic treatment can obviously improve AMI2 diabetes patient＇s blood vessels and the ventricular remodeling and improve heart function,extend the patients survival.Its mechanism may be associated with lower AMI inflammatory mediators.
出处
《西部医学》
2016年第3期372-374,378,共4页
Medical Journal of West China
基金
重庆市指导性科技计划项目(20143003)
关键词
急性心肌梗死
Ⅱ型糖尿病
强化降糖
心肌及血管重构
心功能
炎性介质
Acute myocardial infarction
Type 2diabetes
Strengthening hypoglycemic
Myocardial and vascular remodeling
Cardiac function
Inflammatory interstitial
