OBJECTIVE: To compare the effects of high, middle and low doses of enalapril in preventing left ventricular remodeling (LVRM) after acute myocardial infarction (AMI) in rats, especially evaluating the efficacy of low ...
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OBJECTIVE: To compare the effects of high, middle and low doses of enalapril in preventing left ventricular remodeling (LVRM) after acute myocardial infarction (AMI) in rats, especially evaluating the efficacy of low dose enalapril. METHODS: AMI was induced by ligating the left coronary artery in 149 female SD rats. 48 hours after the procedure, the 97 surviving rats were randomized to one of the following four groups: (1) AMI controls (n = 24), (2) high-dose (10 mg x kg(-1) x d(-1), n = 25), (3) middle-dose (1 mg x kg(-1) x d(-1), n = 23), and (4) low-dose (0.1 mg x kg(-1) x d(-1), n = 25) enalapril groups. In addition, sham-operated (n = 13) and normal rats (n = 10) were randomly selected to serve as non-infarction controls. Enalapril was delivered by direct gastric gavage. After 4 weeks of therapy, hemodynamic studies were performed, then the rat hearts were fixed with 10% formalin and pathology analysis was performed. Exclusive of the dead rats and those with MI size 55%, complete experimental data were obtained from 67 rats, which were comprised of (1) AMI controls (n = 13), (2) high-dose enalapril (n = 13), (3) middle-dose enalapril (n = 12), (4) low-dose enalapril (n = 12), (5) sham-operated (n = 8) and (6) normal (n = 9) groups. RESULTS: There were no significant differences among the four AMI groups in infarction size (all P > 0.05). Compared with the sham-operated group, the left ventricular (LV) end diastolic pressure (LVEDP), volume (LVV), absolute and relative weight (LVAW, LVRW) in AMI group were all significantly increased (all P
目的 了解糖尿病合并非ST段抬高急性冠状动脉综合征（ACS）患者的临床特点、治疗及远期预后.方法 在我国北方38个中心连续入选因非ST段抬高ACS住院的患者,记录既往病史、入院情况、住院期间主要治疗和心血管事件,并在发病6、12和24个月对所有患者进行随访.采用Kaplan-Meier牛存分析比较糖尿病和非糖尿病患者2年累计事件发生率,Cox回归多因素分析用于2年累计死亡影响因素的识别.结果 共注册非ST段抬高ACS住院患者2294例,其中已知糖尿病患者420例,占18.3%.平均年龄（64.9±6.7）岁,高于非糖尿病患者的（62.3±8.6）岁（P〈0.01）,女性患者（占48.1%）、既往有高血压病、心肌梗死、心力衰竭、卒中者均多于非糖尿病患者.合并糖尿病患者住院期间抗血小板约物的应用（92.1%比95.0%,P〈0.05）、接受冠状动脉造影（30.0%比36.3%,P〈0.05）和冠状动脉介入治疗（12.1%比18.8%,P〈0.05）的患者少于非糖尿病者.住院期间以及2年累计的死亡、慢性心力衰竭以及心肌梗死、卒中、心力衰竭和死亡的联合终点事件发生率均明显高于非糖尿病者.多因素回归分析显示,年龄≥70岁、糖尿病、既往心肌梗死、既往心力衰竭、就诊时收缩压〈90 mm Hg（1 mm Hg=0.133 kPa）和心率〉100次/min是非ST段抬高ACS患者2年死亡的危险因素.结论 合并糖尿病的非ST段抬高ACS患者住院期间和2年死亡、慢性心力衰竭和联合终点事件发牛率明显高于非糖尿病者.糖尿病是非ST段抬高ACS患者2年死亡的独立危险因素.我国非ST段抬高ACS患者住院期间抗血小板治疗和早期介入检杳和治疗有待加强.有必要进行更有针对性的大规模临床研究,以提高糖尿病并发ACS的治疗水平,改善该人群的预后。
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