论文部分内容阅读
目的:观察不同同型半胱氨酸(Hcy)水平的2型糖尿病患者冠心病严重程度及心律失常发生情况。方法:选择确诊的2型糖尿病合并冠心病88例,根据血清Hcy水平分为Hcy重度升高组36例、Hcy轻度升高组23例和Hcy正常组29例。入组病例均行256排螺旋CT(MSCT)及24h动态心电图(DCG)检查,比较组间冠状动脉粥样硬化严重程度及心律失常的发生情况。结果:(1)Hcy重度升高组冠脉重度、中度狭窄比例显著或非常显著高于Hcy轻度升高组及Hcy正常组(P<0.05,P<0.01)。本组病例共检出冠脉中重度狭窄670个节段,其中,累及左冠状动脉前降支(LAD)共380个节段(56.7%),非常显著高于回旋支(LCX)、右冠状动脉(RCA)及其他部位(P<0.01);不同Hcy水平组间冠脉中重度狭窄累及部位差异不显著(P>0.05)。(2)Hcy重度升高组各类型心律失常发生率均显著或非常显著高于Hcy轻度升高组及Hcy正常组,其中,恶性心律失常(频发室性期前收缩、成对室性期前收缩、短阵室性心动过速)发生率非常显著高于Hcy轻度升高组及Hcy正常组(P<0.05,P<0.01)。结论:血清Hcy水平重度升高的2型糖尿病合并冠心病患者,其冠状动脉病变更严重,恶性心律失常的发生率显著增加。
Objective: To observe the severity of coronary heart disease and arrhythmia in type 2 diabetic patients with different homocysteine (Hcy) levels. Methods: Eighty-eight patients with type 2 diabetes mellitus complicated with coronary heart disease were selected. According to the level of serum Hcy, there were 36 patients with severe Hcy increased, 23 patients with mild Hcy and 29 patients with normal Hcy. All patients were examined by 256-slice spiral CT (MSCT) and 24h dynamic electrocardiogram (DCG). The severity of coronary atherosclerosis and arrhythmia were compared between groups. Results: (1) The severity of severe coronary artery stenosis and moderate stenosis in severe Hcy increased significantly or significantly higher than that in mild Hcy and normal Hcy group (P <0.05, P <0.01). A total of 670 segments of moderate to severe coronary artery stenosis were detected in this group, of which 380 segments (56.7%) involving the left anterior descending coronary artery (LAD) were significantly higher than LCX, (RCA) and other sites (P <0.01). There was no significant difference in the severity of coronary stenosis among different Hcy groups (P> 0.05). (2) The incidence of various types of arrhythmia in severe Hcy increased group was significantly higher than that in mild Hcy group and normal Hcy group (malignant arrhythmia (frequent premature ventricular contraction, paired ventricular Premature rupture, paroxysmal ventricular tachycardia) incidence was significantly higher than mild Hcy and Hcy normal group (P <0.05, P <0.01). CONCLUSIONS: Type 2 diabetes mellitus patients with severe elevated serum Hcy levels have more severe coronary artery disease and a marked increase in the incidence of malignant arrhythmias.