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目的:探讨糖尿病急性心肌梗死经皮冠状动脉介入治疗(PCI)术后患者心肌梗死区存活心肌对左室重构及左心功能的影响。方法:208例2型糖尿病并急性心肌梗死PCI术后的患者接受静息状态下18-氟脱氧葡萄糖正电子发射断层扫描术(18F-FDG PET)心肌代谢显像与99m锝-甲氧基异丁基异腈单光子发射型计算机断层成像术(99Tcm-MIBI SPECT)心肌灌注显像,根据心肌梗死区有无存活心肌,分为有心肌存活组(115例,灌注-代谢不匹配)和无心肌存活组(93例,灌注一代谢匹配)。检测两组PCI术前、术后超声心动图各指标,观察心肌梗死区心肌存活状态对于左室重构以及心功能的影响。结果:心肌梗死12个月后有存活心肌组左室射血分数(LVEF)显著高于无存活心肌组[(46.7±6.98)%比(44.1±7.12)%],左室舒张末期内径(LVEDd)[(53.17±4.77)mm比(55.46±4.75)mm],左房内径[(35.89±12.08)mm比(39.25±11.31)mm]显著小于无存活心肌组,P均<0.05。舒张期二尖瓣血流速度峰值的比值12个月后两组无显著差异(P>0.05)。结论:于2型糖尿病合并急性心肌梗死的患者,心肌梗死区有存活心肌患者较无心肌存活患者,LVEF明显改善,左室舒张末期内径显著缩小。
Objective: To investigate the effect of viable myocardium in myocardial infarction area on left ventricular remodeling and left ventricular function in diabetic patients with acute myocardial infarction after percutaneous coronary intervention (PCI). METHODS: Totally 208 patients with type 2 diabetes mellitus and acute myocardial infarction underwent myocardial metabolic imaging with 18F-FDG PET at resting status and 99m Tc-methoxyisolate Butyl isonitrile single photon emission computed tomography (99Tcm-MIBI SPECT) myocardial perfusion imaging, according to the existence of myocardial viable myocardial infarction area, divided into myocardial survival group (115 cases, perfusion - metabolic mismatch) and no myocardial survival Group (93 cases, perfusion of a metabolic match). The indexes of echocardiography before and after PCI were detected in both groups, and the effect of myocardial viability in myocardial infarction area on left ventricular remodeling and cardiac function was observed. Results: Left ventricular ejection fraction (LVEF) in surviving myocardium was significantly higher than that in non-viable myocardium [(46.7 ± 6.98)% vs (44.1 ± 7.12)%], LVEDd ) (53.17 ± 4.77) mm (55.46 ± 4.75) mm, and the left atrium diameter (35.89 ± 12.08 mm vs 39.25 ± 11.31 mm) was significantly lower than that of the non-viable myocardium (P <0.05). Diastolic mitral flow velocity peak value ratio after 12 months there was no significant difference between the two groups (P> 0.05). CONCLUSIONS: In patients with type 2 diabetes mellitus complicated with acute myocardial infarction, patients with viable myocardium in myocardial infarction have a significantly improved LVEF and a significantly reduced left ventricular end-diastolic diameter compared with patients without myocardial viability.