王瑞萍 钱贻简 陈曼丽 100730 北京医院内科 中华内科杂志 1998 10 37 10


    关键词：糖尿病；心肌疾病 期刊 zhnkzz 0 论 著 fur -->


    

【摘要】 目的 进一步认识糖尿病对老年人心脏的影响。方法 回顾性总结1984～1993年51例老年糖尿病和同期85例非糖尿病老人心脏的临床及尸检材料。结果 糖尿病组的冠心病及心肌梗塞的患病率及心力衰竭的发生率均高于非糖尿病组。糖尿病组冠心病的发病年龄较非糖尿病组早5年。尸检表明，与非糖尿病组比较，糖尿病组冠状动脉病变严重，累及支数也多，且心肌内小冠状动脉壁增厚者明显地多。有1例病理诊断为糖尿病性心肌病。结论 糖尿病对老年人心脏的影响主要表现为冠状动脉病变加重，心肌内小冠状动脉管壁增厚，心肌内灶性坏死和间质纤维化增多。这与糖尿病并发心力衰竭较多有关。

    The clinical and pathological findings of diabetic heart disease in the aged Wang Ruiping, Qian Yijian, Chen Manli. Department of Internal Medicine, Beijing Hospital,Beijing 100730

    【Abstract】 Objective To understand further the effects ofdiabetes mellitus(DM) on the heart of aged. Methods The clinical andpathological data of 51 aged diabetic cases autopsied in a 10-year period from 1984 to1993 were compared with those of 85 non-diabetic cases autopsied in the same period withemphasis on the effects of DM on the heart. Results Clinically, thenumber of cases diagnosed as coronary heart disease(CHD, 90.2%), myocardial infarction(MI,49.0%) and acute MI before death(31.4%) and the rate of reinfarction (56.0%) and mortality(31.4%) were higher in the diabetics than in the non-diabetics (75.3%, 30.6%, 20.0%, 34.6%and 20.0% respectively). Cases with heart failure were much more in the diabetics (68.8%)than in the non-diabetics (27.1%). It is also noted that the diabetics suffered from CHDfive years earlier on the average than the non-diabetics. Pathologically, cases withcoronary stenosis of ≥grade III were more in the diabetic (62.7%) than in thenon-diabetic (44.7%) group. A significant finding was that cases with thickening of thewall of intramural small coronary arteries were much more in the diabetic (21.6%) thannon-diabetic group (2.4%). Of the 51 diabetic cases one was diagnosed as diabetic cardiomyopathy. Conclusion The effects of DM on the heart of the agedare mainly the results of angiopathy. Firstly, it is the result of macroangiopathy whichaggravates coronary stenosis and leads to earlier onset and more severe lesion. Secondly,it is the result of microangiopathy, as shown by the prevalence of thickening of the wallof intramural small coronary arteries, which might be related with the high incidence ofheart failure in the diabetics. Diabetic cardiomyopathy was diagnosed only in one case, asthere has been no pathognomonic sign both clinically and pathologically.

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