糖尿病酮症对中青年患者心脏的影响

摘要

Objective To observe the changes of myocardial enzymogram and myocardial damage during diabetic ketosis (DK)or diabetic ketoacidosis(DKA) in young and middle-aged patients. Methods Seventy-eight hospitalized patients (45 male and 33 female) of DKA were recruited. Myocardial enzymogram which included crea-tine phosphokinase (CK), creatine phosphokinase isoenzyme (CK-MB) and aspart aminotransferases (AST) was measured on admission at ketosis stage and on 7 days after ketosis recovery. Electrocardiographs were also performed and compared during those two stages. Results Seventy-eight hospitalized patients with DK or DKA had signifi-cantly higher levels of myocardial enzymogramCK, CK-MB and AST at ketosis stage than those in stable stage. The changes of ECG were found in 46 cases (58.9%)of all the patients. The highest morbidity of ECG abnormality was ST-T change which was found in 32 cases(41.0%), ST segment depression in 8 cases, ST segment height in 1 case, T wave flat or inversion in 23 cases, sinus tachycardia in 18 cases (23.1%). 32 of 46 cases with abnormal ECG improved on 7th day with ketosis recovery, furthermore,20 cases fully recovered. The levels of CK, CK-MB and AST with abnormal ECG in acute stage were significantly higher than those with normal ECG. 3 patients had severe ketoacidesis, minute elevations of myocardial biomarkers showed 2 folds above reference value. ST segment showed depression of 0.1 mV in 2 cases and ST segment elevated in 1 case. The high levels of CK, CK-Mb and AST and changes of ECG restored in the stable stage. T segment restored 0.05 mV in 2 patient with ST segment depression and ST segment elevation in 1 case restored to normal also. Conclusions Diabetic ketoacidosis has a nonspecific myocardial injury. The myocardial changes should be monitored and effective protective therapy should be taken during ketosis episode.%目的 通过观察中青年糖尿病酮症患者心肌酶谱以及心电图改变,探讨糖尿病酮症对心脏的损害.方法 入选78例中青年2型糖尿病酮症患者,急性期及酮症纠正后检测肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)及天门冬氨基转移酶(AST);同时观察并比较患者心电图的变化.结果 78例酮症期患者血清肌酸激酶、CK-MB及AST水平与缓解期比较均明显升高;78例急性期患者心电图异常者46例(58.9%),主要异常是ST-T改变32例(41.0%),其中ST段压低8例,ST段抬高1例,T波平坦或倒置23例,窦性心动过速18例(23.1%),缓解期有32例心电图异常的患者好转,其中20例恢复正常;急性期心电图异常患者组血清肌酸激酶、CK-MB及AST水平明显高于心电图正常组(P<0.05);78例患者中有3例酮症患者急性期肌酸激酶、CK-MB及AST超过正常值2倍,2例患者ST段压低0.1 mV,1例患者ST段轻度抬高,缓解期肌酸激酶、CK-MB及AST恢复正常,3例心电图均有明显改善,2例ST段压低患者升高0.05 mV以上,ST段抬高者恢复到基线水平.结论 糖尿病酮症患者存在心脏一过性非特异性损害,心肌酶谱可以出现异常升高,酮症期间应重视心脏的监测,酮体纠正后应重视心脏的随访与评价.