【作者】 李庆凤；

【导师】 苏珂；

【作者基本信息】 桂林医学院 ， 内科学， 2011， 硕士

【摘要】 目的探讨非急性心梗2型糖尿病(T2DM)患者血清心肌肌钙蛋白T(cTnT)升高的临床意义,为2型糖尿病心血管并发症的预防、早期诊断与治疗提供新的思路。方法参照24小时尿白蛋白排泄率选择T2DM患者180例,上述对象均剔除近3个月内急性心梗、自身免疫性疾病、血液系统疾病、甲状腺疾病、严重感染、风湿性心脏病、原发性心肌病、原发性肾病、严重肝脏疾病。第1次检测血清cTnT大于正常值的患者连续复查心电图、cTnT,排除入组时为急性心肌梗死病例。结合糖尿病肾病Mogensen分期标准将所纳入研究对象为三组:尿白蛋白<30mg/D组(A组)60例;尿白蛋白介于30～300mg/D组(B组)60例;尿白蛋白>300mg/D或Scr高于参考值组(C组)60例。三组间的性别构成差别无统计学意义。再根据cTnT值分为cTnT阳性组及cTnT阴性组。测定T2DM患者血清cTnT、随机血糖(RBG)、果糖胺(FA)、糖化血红蛋白(HbA1C)、肝肾功能、血脂、C反应蛋白(CRP)。随访120天,观察患者心血管事件及死亡事件的发生情况,分析其与cTnT的关系。结果(1)180例T2DM患者cTnT升高25例,其中尿白蛋白低于30mg/D组(A组,60例)cTnT升高1例;尿白蛋白介于30-300mg/D组(B组,60例)cTnT升高4例;尿白蛋白大于300mg/D或Scr高于参考值组(C组,60例)cTnT升高20例。(2)cTnT升高25例患者中发生心血管事件16例,死亡8例, 7例死于心血管事件; cTnT正常155例中发生心血管事件6例,死亡4例,其中1例死于心血管事件,两组比较差异有统计学意义(P<0.01)。(3)cTnT阳性组与阴性组比较: TG、TC、LDL-c、FA、HbA1c均数比较差异均无统计学意义;cTnT阳性组CRP水平明显高于cTnT阴性组(P<0.05);cTnT阳性组Hb水平明显低于cTnT阴性组(P<0.01),ALB水平也明显低于cTnT阴性组(P<0.05);cTnT阳性组患者多为老年患者,与cTnT阴性组相比,年龄差异有统计学意义(P<0.01)。结论(1)随着糖尿病肾病进展, cTnT升高阳性率增加。(2)2型糖尿病患者血清cTnT水平升高与心脏微血管病变导致的心肌损伤有关,可以预测患者病死率及心血管事件的发生率。(3)对于具有高度心血管危险水平的老年糖尿病患者,单纯严格的血糖控制并不能有效降低其大血管事件危险性。更多还原

【Abstract】 Objective: To investigate the clinical significance of elevated cTnT in patients with type 2 diabetes mellitus whithout acute myocardial infarction . To provide a new thinking to prevent,early diagnose and to treat for the cardioascular complications of type 2 diabetes mellitus .Methods:Referering to the 24-hour urinary albumin excretion rates,the 180 patients with T2DM were choosed and the participants above-mentioned were without acute myo- cardial infarction, autoimmune diseases, blood systemic diseases, thyroid diseases, serious infection, of rheumatic heart disease, primary cardiomyopathy, primary nephro- pathy, severe hepatopathy during the past three months. The electrocardiogram and cTnT in the patients with serum cTnT beyond the scope of normal reference value in the first determination were determined repeatly to exclude the cases with acute myocardial infarction . According to the diabetes nephropathy Mogensen staging system,the diabetic patients researchede were devided into three groups: The group A was composed with the diabetic patients whose urinary albumin below 30mg/D(n:60). The group B was composed with the diabetic patients whose urinary albumin between 30 and 300mg/D group (n: 60). The group C was composed with the diabetic patients whose urinary albumin > 300mg/D or Cr above reference (n: 60). There was not statistically significance difference in gender constitute of the three groups. The diabetic patients researched were then divided into cTnT positive group and cTnT negative group according to determination values of cTnT.The serum cTnT,random blood glucose, fructose- amine, glycated hemoglobin,hepatic function,renal function,blood-fat, C reactive protein in all patients were determined. In 120-days follow-up, observe the incidence of cardiovascular events and death events in patients were observed,the relationship between the incidence and cTnT was analyzed.Results: (1)There were 25 patients with elevated cTnT among 180 cases of T2DM patients. Of them cTnT increased in one patient in group A whose Urinary albumin less than 30mg / D (60 cases) ; cTnT increased in 4 patients in group B(Urinary albumin between 30-300mg / D as group B,60 cases); cTnT increased in 20 patients in group C(Urinary albumin greater than 300mg / D or Scr higher than the reference value as C group,60 cases). (2)Of 25 patients with elevated cTnT 16 patients had cardiovascular events , 8 died and among the died patients 7 patients died of cardiovascular events. Among 155 patients with normal cTnT ,6 patients occurred cardiovascular events. Of them 4 died, 1 of which died of cardiovascular events. There was significant difference between wo groups (P <0.01). (3)CTnT positive and negative groups were compared as follows: there were not statistically significant differences in the means’comparative of TG, TC, LDL - c, FA and HbA1c ; cTnT positive group’s CRP level was significantly higher than cTnT negative group (P < 0.05); cTnT positive group’s Hb level was obviously lower than cTnT negative group (P < 0.01) and ALB level was also obviously lower than cTnT negative group’s (P < 0.05); the majority of the patients in CTnT positive group were the aged, compared with cTnT negative group, the difference in age was statistically significant (P < 0.01).Conclusions: (1)With the progress of diabetic nephropathy, the positive rate of elevated cTnT increases.(2)Elevated cTnT which were related with myocardial injury induced by cardiac microangiopathy in type 2 diabetes patients can predict the patient mortality and the incidence of cardiovascular events.(3)Simply strictly controling blood glucose cannot effectively reduce their big vascular events’ risks for elderly diabetic patients with highly cardioascular risk level .更多还原