| Background and ObjectivesThe clinical studies have proved that patients with diabetes mellitus or high blood pressure have critical conditions, much complications and poor prognosis as well when they suffer form the acute myocardial infarction(AMI). To study the reasons, we measured the dynamic changes of the sensitive and specific myocardial infarction indicators such as cardiac troponin T(cTnT). At the same time we measured the similar dynamic changes of the serum creatine kinase MBmass (CK-MBmass) and creatine kinase MBactivity(CK-MBact). According to the time-change curve, we calculated the quantity of the myocardial infarction. In this research, we would study the extent degree of the myocardial infarction range in the patients with diabetes mellitus or high blood pressure and give the the incidence of AMI associated with diabetes, hypertension on myocardial infarction sizes and provide methodologies and quantitative indicators.Materials and MethodsChoose 62 patients with AMI in the Qianfoshan Hospital of Shandong Province. According to the complications the total 62 patients were divided into three groups: group A enrolled 18 patients who were AMI with diabetes mellitus, group B enrolled 21 patients who were AMI with hypertension, group C enrolled 23 patients who were AMI without diabetes mellitus or hypertension.1. Specimen collection and testing:All the patients should be taken 2ml venous blood immediately and per 8-12 hours after coming into the hospital. Then the blood samples centirfuged for 5 minutes by 3000r/min and the serum was taken out for measurement.2. Relative serum items:Then we measured the dynamic changes of the serum cTnT, CK-MBmass and CK-MBact as well.3. Computer procedure:In this research we applied VISUAL BASIC into editing the procedure.Then we caculated the quantity which was performanced by cTnT-g, CK-MB mass-g, CK-MBact-g according to cTnT, CK-MBmass, CK-MBact respectively.Results1. According to the abnormal changes of serum cTnT, CK-MBmass, CK-MBact levels value of time, group A appeared at 3.3±0.6 h,1.8±0.4 h,2.9±0.7 h, while group B appeared at 3.0±0.5 h,1.6±0.3 h,2.6±0.6 h and group C appeared at 3.1±0.4 h,1.7±0.2 h,2.7±0.4 h respectively. Comparison among three groups showed no significant difference.2. According to the maximal values of cTnT, CK-MBmass and CK-MBact, group A appeared at 38.9±8.6 h,28.5±4.9 h,32.4±5.2 h respectively, while group B appeared at 35.4±7.9 h,26.7±4.2 h,29.5±4.8 h and group C appeared at 30.5±5.1 h,18.2±3.1 h,20.7±4.5 h respectively. There was not significant difference between group A and group B (P>0.05), and there was significant difference between group A (or B) and group C (P<0.01).3. According to the peak lasted time of cTnT, CK-MBmass and CK-MBact, group A were 78.2±16.5 h,18.2±4.2 h,21.3±4.8 h respectively, group B were 68.5±15.4 h,16.4±3.5 h,18.4±4.2 h and group C were 57.4±12.7 h,9.5±2.8 h,12.5±3.6 h respectively. There was not significant difference between group A and group B (P>0.05), and there was significant difference between group A (or B) and group C (P<0 .01).4. For those return to baseline levels of cTnT, CK-MBmass and CK-MBact, group A were 78.5±16.5 h,58.7±13.8 h,62.5±15.6 h, group B were 72.6±14.3 h, 52.4±11.5 h,58.6±12.7 h and group C were 63.2±10.3 h,41.7±8.5 h,52.5±10.5 h respectively. There was not significant difference between group A and group B (P > 0.05), and there was significant difference between group A (or B) and group C (P <0.01).5. According to the rising rates of cTnT, CK-MBmass and CK-MBact, group A were 0.2354±0.0625 h,0.1692±0.0431 h,0.1575±0.0426 h, group B were 0.2478±0.0656 h,0.1968±0.0485 h,0.1879±0.0452 h, group C were 0.3798±0.0943 h, 0.2435±0.0612 h,0.2513±0.0608 h. There was not significant difference between group A and group B (P>0.05) according to cTnT, CK-MBmass, and significant difference between group A and group B (P<0.05).There was significant difference between group A (or B) and group C (P<0.01).6. According to the dropping rates of cTnT, CK-MBmass and CK-MBact, group A were 0.0734±0.0235 h-1,0.0416±0.0137 h-1,0.0421±0.0129 h-1,group B were 0.0815±0.0318 h'-1,0.0435±0.0158 h-1,0.0423±0.0147 h-1,group C were 0.1344±0.0421 h-1,0.0561±0.0235 h-1,0.0547±0.0212 h-1.There was not significant difference between group A and group B (P>0.05), and there was significant difference between group A (or B) and group C (P<0.01).7. Quantity of myocardial infarction: According to the the average quantity of cTnT, CK-MBmass and CK-MBact, group A were 45.2±13.2 cTnT-g,42.5±11.3 CK-MBmass-g,45.7±12.6 CK-MBact-g, group B were 40.8±9.6 cTnT-g,37.4±9.2 CK-MBmass-g,39.2±10.2 CK-MBact-g, group C were 31.4±7.9 cTnT-g,28.7±6.3 CK-MBmass-g,31.6±7.8 CK-MBact-g. There was not significant difference between group A and group B (P> 0.05), and there was significant difference between group A (or B) and group C (P<0.01).Conclusions1. According to the abnormal changes of cTnT, CK-MBmass and CK-MBact, results showed that there was not difference among three groups and the serum cTnT, CK-MBmass and CK-MBact would help determine the early AMI.2. According to the maximal values of cTnT, CK-MBmass and CK-MBact, the time of the patients associated with diabetes mellitus or high blood pressure was longer than who without diabetes mellitus and high blood pressure by 8.4 h,4.9 h, 10.3 h,8.5 h,11.7 h,8.8 h respectively. The comparison among the three groups demonstrated that the patients associated with diabetes mellitus or high blood pressure had a large number of myocardial cells endangered with ischemic damage and the structural protein was injured and ischemic seriously.3. According to the peak lasted time, the time of the patients associated with diabetes mellitus or high blood pressure was longer than who without diabetes and high blood pressure by 20.8 h,11.1 h,8.7 h,6.9 h,8.8 h,5.9 h respectively. The comparison among the three groups indicated that the patients associated with diabetes or high blood pressure had a large number of injured and irreversible myocardial tissue. The myocardial fibers were released into the blood continuously after the collapse of endangered myocardial injury.4. For those return to baseline levels of cTnT, CK-MBmass and CK-MBact, the time of the patients associated with diabetes or high blood pressure was longer than who without diabetes and high blood pressure by 15.3 h,9.4 h,17.0 h,10.7 h,10.0 h, 6.1 h respectively. The comparison among the groups showed that the myocardial necrosis area prolonged to the ischemic damage zone so that more and more myocardial necrosis happened in the patients associated with diabetes or high blood pressure.5. Based on the increasing and dropping rates of serum cardiac indexs we calculated the myocardial infarction volume. The quantity of myocardial infarction in the patients associated with diabetes or high blood pressure increased than who without diabetes and high blood pressure by 43.9%,29.9%,48.0%,30.3%,44.6%, 24.1% respectively. It demonstrated that quantity of myocardial infarction in the patients associated with diabetes or high blood pressure was significantly increased. |
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