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目的观察阿卡波糖片对老年急性心肌梗死患者心室重构的影响。方法 120例糖耐量降低的老年脑梗死患者分为对照组和试验组,每组60例,另选取60例血糖正常的患者为血糖正常组。试验组患者口服阿卡波糖,开始3d剂量为每次50 mg,每天3次,后改为每次100 mg,每天3次,持续治疗12个月;对照组患者及血糖正常组患者均给予同等剂量的安慰剂,3组均持续治疗12个月。观察3组患者心脏超声检测结果、血液脑钠肽水平及心血管疾病发生情况。结果治疗3,6,9,12个月,试验组左心室舒张末期内径(LEVDD)分别为(54.71±0.52),(53.16±0.39),(47.17±0.43),(44.00±0.41)mm,对照组分别为(57.60±0.50),(53.32±0.70),(47.94±0.44),(47.50±0.49)mm,血糖正常组分别为(54.96±0.40),(53.13±0.30),(47.09±0.35),(43.73±0.33)mm,3组与治疗前比较,差异均有统计学意义(均P<0.05)。治疗3,6,9,12个月,试验组左心室射血分数(LVEF)分别为(60.12±0.49)%,(63.48±0.43)%,(65.52±0.39)%,(66.73±0.34)%,血糖正常组分别为(54.23±0.62)%,(64.10±0.49)%,(65.67±0.48)%,(66.57±0.39)%,(66.79±0.41)%,对照组分别为(52.51±0.86)%,(54.54±4.62)%,(57.36±0.84)%,(64.51±0.39)%,3组与治疗前比较,差异均有统计学意义(均P<0.05)。治疗3,6,9,12个月,血糖正常组脑钠钛(BNP)分别为(141.18±2.32),(169.08±1.17),(178.39±1.81),(181.97±3.85)ng·mL~(-1),试验组分别为(150.00±3.58),(170.91±6.24),(180.54±5.99),(190.68±5.07)ng·mL~(-1),对照组分别为(149.53±4.08),(498.45±17.12),(538.28±14.88),(547.89±12.46)ng·mL~(-1),3组与治疗前比较,差异均有统计学意义(均P<0.05)。试验组患者治疗后BNP水平接近于血糖正常组,但是差异仍有统计学意义(P<0.05)。试验组再发急性心肌梗死的发生率为8.33%(5/60例),充血性心力衰竭的发生率为31.67%(19/60例);对照组再发急性心肌梗死的发生率为20.00%(12/60例),充血性心力衰竭的发生率为51.67%(31/60例,P<0.05)。结论患者发生急性心肌梗死后通常会引起糖耐量降低,对心室重构具有促进作用,而阿卡波糖能够有效缓解老年急性心肌梗死患者的心室重构。
Objective To observe the effect of acarbose on ventricular remodeling in elderly patients with acute myocardial infarction. Methods A total of 120 elderly cerebral infarction patients with impaired glucose tolerance were divided into control group and trial group, with 60 cases in each group. Another 60 cases with normal blood glucose level were normal blood glucose group. The patients in the experimental group were given acarbose orally, and the initial dose of 3d was 50 mg every time for three times a day, then changed to 100 mg twice a day for 12 months. Patients in the control group and patients with normal blood glucose were given The same dose of placebo, 3 groups were treated for 12 months. The results of echocardiography, blood brain natriuretic peptide and the incidence of cardiovascular diseases in the three groups were observed. Results The left ventricular end-diastolic diameter (LEVDD) in the experimental group were (54.71 ± 0.52), (53.16 ± 0.39), (47.17 ± 0.43) and (44.00 ± 0.41) mm respectively at 3, 6, 9 and 12 months after treatment Group were (57.60 ± 0.50), (53.32 ± 0.70), (47.94 ± 0.44) and (47.50 ± 0.49) mm, respectively, and those in the normal blood glucose group were (54.96 ± 0.40), (53.13 ± 0.30) and (47.09 ± 0.35) , (43.73 ± 0.33) mm, respectively. There were significant differences between the three groups before treatment (all P <0.05). The left ventricular ejection fraction (LVEF) in the experimental group was (60.12 ± 0.49)%, (63.48 ± 0.43)%, (65.52 ± 0.39)%, (66.73 ± 0.34)% , (54.23 ± 0.62)%, (64.10 ± 0.49)%, (65.67 ± 0.48)%, (66.57 ± 0.39)% and (66.79 ± 0.41)% respectively in the control group and (52.51 ± 0.86) %, (54.54 ± 4.62)%, (57.36 ± 0.84)%, (64.51 ± 0.39)%, respectively. There were significant differences between the three groups before treatment (all P <0.05). The BNP levels in normal blood glucose group were (141.18 ± 2.32), (169.08 ± 1.17), (178.39 ± 1.81) and (181.97 ± 3.85) ng · mL ~ (-1) -1) in the control group were (150.00 ± 3.58), (170.91 ± 6.24), (180.54 ± 5.99) and (190.68 ± 5.07) ng · mL -1, respectively, and those in the control group were (149.53 ± 4.08) and (498.45 ± 17.12), (538.28 ± 14.88) and (547.89 ± 12.46) ng · mL ~ (-1), respectively. The differences between the three groups were statistically significant (all P <0.05). The level of BNP in the test group was close to that in the normal group, but the difference was still statistically significant (P <0.05). The incidence of recurrent acute myocardial infarction was 8.33% (5/60) in experimental group and 31.67% (19/60 cases) in congestive heart failure. The incidence of recurrent acute myocardial infarction in control group was 20.00% (12/60 cases). The incidence of congestive heart failure was 51.67% (31/60 cases, P <0.05). Conclusion Patients with acute myocardial infarction usually cause impaired glucose tolerance and promote ventricular remodeling. Acarbose can effectively relieve ventricular remodeling in elderly patients with acute myocardial infarction.