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目的探讨急性心肌梗死(AMI)发病前伴有糖尿病、高血压对心肌梗死范围影响的程度。方法选取2006年6月～2008年6月收住院的AMI患者62例,根据AMI发病前是否伴有合并症分为3组,其中伴有糖尿病18例为A组;伴有高血压21例为B组;不伴有糖尿病和高血压23例为C组。测定AMI患者血清肌钙蛋白T(cTnT)、肌酸激酶-MBmass(CK-MBmass)、肌酸激酶-MB活性(CK-MBact)的动态变化情况。结果①血清cTnT、CK-MBmass、CK-MBact出现异常值的时间,A组患者分别平均为3.9、2.9和3.0 h;B组患者分别平均为3.5、1.6和2.3 h;C组患者分别平均为2.8、1.3和1.7 h;②上升至峰值的时间,A组患者分别平均为38.9、28.5和32.4 h;B组患者分别平均为35.4、26.7和29.5 h;C组患者分别平均为30.5、18.2和20.7 h;③自峰值下降至正常的时间,A组患者分别平均为78.5、72.6和63.2 h;B组患者分别平均为58.7、52.4和41.7 h;C组患者分别平均为62.5、58.6和52.5 h;④根据动态变化计算心肌梗死量,A组患者分别平均为45.2 cTnT-g、42.5 CK-MBmass-g、45.7 CK-MBact-g;B组患者分别平均为40.8 cTnT-g、37.4 CK-MBmass-g、39.2 CK-MBact-g;C组患者分别平均为31.4 cTnT-g、28.7 CK-MBmass-g、31.6CK-MBact-g。结论AMI发病前伴有糖尿病、高血压的患者病情重,并发症发生率高,心肌梗死范围明显增大。
Objective To investigate the extent of the effects of diabetes mellitus and hypertension on myocardial infarction size before onset of acute myocardial infarction (AMI). Methods Sixty-two AMI patients admitted to hospital from June 2006 to June 2008 were divided into three groups according to whether they had comorbidities before onset of AMI. Among them, 18 patients with diabetes mellitus were in group A, and 21 patients with hypertension B group; without diabetes and hypertension in 23 cases for the C group. The dynamic changes of serum cTnT, CK-MBmass and CK-MBact in patients with AMI were measured. Results ① The abnormal time values of serum cTnT, CK-MBmass and CK-MBact were 3.9, 2.9 and 3.0 h in group A, 3.5, 1.6 and 2.3 h in group B. The average of group C was 2.8, 1.3 and 1.7 h respectively. ② The time to peak value was 38.9, 28.5 and 32.4 h in group A, 35.4, 26.7 and 29.5 h in group B, and 30.5 and 18.2 in group C 20.7 h, respectively; ③At peak-to-normal time, patients in group A averaged 78.5,72.6 and 63.2 h respectively; patients in group B averaged 58.7, 52.4 and 41.7 h respectively; patients in group C averaged 62.5, 58.6 and 52.5 h ; ④The amount of myocardial infarction was calculated according to the dynamic changes. The patients in group A averaged 45.2 cTnT-g, 42.5 CK-MBmass-g and 45.7 CK-MBact-g respectively, while the average in group B was 40.8 cTnT-g and 37.4 CK- -g and 39.2 CK-MBact-g respectively. The mean of patients in group C was 31.4 cTnT-g, 28.7 CK-MBmass-g and 31.6CK-MBact-g respectively. Conclusions Patients with diabetes mellitus and hypertension before onset of AMI have severe illness, high incidence of complications and a marked increase in the scope of myocardial infarction.