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DM并发AMI的病死率较高,有报道为40％,至少是非DM患者的2倍。多项研究表明,DM并AMI治疗中尽早应用ACEI,可明显降低病死率,现就其可能机制试作一综述。 1 抑制心脏组织的RAS,防止心室重构 DM患者存在加速心室重构的多种危险因素:①首次发生有症状MI前约40％有无痛性心肌梗塞病史;②心脏植物神经病变存在于几乎50％的有冠脉病变的DM患者,可直接导致收缩和舒张功能不全;③糖尿病性心肌病是一种舒张功能先于收缩功能障碍的亚临床状态;④高血压和高血糖并存引起心肌纤维化的程度要比其单独存在严重;⑤内皮功能障碍减少了冠脉微血管的灌注,导致心脏缺血;⑥三大物质代谢紊乱使ATP生成减少,氧自由基产生增多,心肌氧耗增加,致心肌收缩
The mortality rate of DM complicated with AMI is higher, which is reported as 40%, at least twice that of non-DM patients. A number of studies have shown that the early application of ACEI in the treatment of DM and AMI can significantly reduce the case fatality rate. A review on possible mechanisms is now being made. 1 inhibition of heart tissue RAS to prevent ventricular remodeling DM there are a variety of risk factors to accelerate ventricular remodeling: ① the first occurrence of symptomatic MI before 40% had a history of painless myocardial infarction; ② cardiac autonomic lesions exist in almost 50% of diabetic patients with coronary artery disease, can directly lead to systolic and diastolic dysfunction; ③ diabetic cardiomyopathy is a diastolic function prior to systolic dysfunction in subclinical conditions; ④ high blood pressure and hyperglycemia coexist causing myocardial fibers The severity of the existence than its separate serious; ⑤ endothelial dysfunction reduces coronary microvascular perfusion, leading to cardiac ischemia; ⑥ three major metabolic disorders make ATP production decreased oxygen free radicals increased myocardial oxygen consumption caused by Myocardial contractions