Brown H B, Waugh N R, Jennings P E
Department of Medicine, Ninewells Hospital and Medical School, Dundee.
Scott Med J. 1992 Apr;37(2):44-6. doi: 10.1177/003693309203700206.
Diabetic patients have an increased mortality following myocardial infarction (MI) due to left ventricular failure rather than larger infarcts or dysrhythmias. As this may be due to diabetic microangiopathy affecting the myocardium, we have examined the case records of diabetic clinic patients admitted to the Coronary Care Unit (CCU) with proven MI and compared the hospital outcome of those with and without retinopathy or nephropathy, i.e. markers for generalised microangiopathy. Sixty four consecutive records were traced, for the period when diabetic treatment policy was standardised in CCU, 24 patients had retinopathy (7 proteinuria). When compared to non-retinopathy patients they had similar ages 67 +/- 12 yr [+/- SD] v 63 +/- 9yr) but were of longer duration of diabetes p less than 0.05). There were no differences between the groups in size or site of infarct, previous infarct or hypertension history, blood glucose on admission or diabetic treatment before or after admission. Death occurred in 29% of retinopathy patients compared to 3% of non-retinopathy patients (p less than 0.01). Cardiac failure complicated 75% of retinopathy patients and 25% of non-retinopathy patients (p less than 0.001). Dysrhythmia occurred in 50% and 33% of patients respectively (P = NS). Nine patients had clinical peripheral vascular disease and five of these died. This study, of a selected group of diabetic clinic attenders admitted to CCU with acute MI, demonstrates that microangiopathy and peripheral vascular disease are important prognostic factors in determining hospital outcome as these patients are at increased risk of cardiac failure and death.
糖尿病患者心肌梗死后死亡率增加，原因是左心室衰竭，而非梗死面积更大或心律失常。由于这可能是糖尿病微血管病变累及心肌所致，我们检查了冠心病监护病房（CCU）收治的确诊心肌梗死的糖尿病门诊患者的病历，并比较了有视网膜病变或肾病（即全身性微血管病变的标志物）和无这些病变患者的住院结局。在CCU糖尿病治疗策略标准化期间，追踪了64份连续病历，24例患者有视网膜病变（7例有蛋白尿）。与无视网膜病变患者相比，他们年龄相似（67±12岁[±标准差]对63±9岁），但糖尿病病程更长（p<0.05）。两组在梗死面积或部位、既往梗死或高血压病史、入院时血糖或入院前后糖尿病治疗方面均无差异。视网膜病变患者死亡率为29%，无视网膜病变患者为3%（p<0.01）。75%的视网膜病变患者并发心力衰竭，无视网膜病变患者为25%（p<0.001）。心律失常分别发生在50%和33%的患者中（P=无显著性差异）。9例患者有临床外周血管疾病，其中5例死亡。这项对入选CCU的急性心肌梗死糖尿病门诊患者的研究表明，微血管病变和外周血管疾病是决定住院结局的重要预后因素，因为这些患者发生心力衰竭和死亡的风险增加。
