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1、糖尿病合并急性心肌梗死(AMI)的临床特点、误诊原因及对策分析湖南省沅江市人民医院湖南沅江413100【摘要】目的：研究糖尿病合并急性心肌梗死(AMI)的临床特点、误诊原因及对策分析。方法：2009年5月至2013年5月在我院确诊为糖鉍病合并AMI的患者和确诊为非糖尿病AMI患者共156例，平均分为2组。探讨两组患者的临床特点、误诊原因以及对策分析。结果：A组患者的GU)、TG、HDL的浓度均明显高于对照组B(P<0.05);A组患者的主要临床症状表现为压榨性胸痛、呼吸困难、胃肠道反应、上腹痛，其发生率分别为41.0%、23.1%、12.8%、14.1%,均明显高于B组(P
2、<0.05),同时A组的弥漫性冠状动脉、重度冠状动脉狭窄的发生率分别为52.6%、50.0%,与B组相比存在显著性差异(P<0.05),而且B组出现典型心肌梗死时间段为6:00-13：59,发病率为53.8%,与A组该时间段发病率显著性差异(P<0.05)；A组患者的误诊率、死亡率、治疗后再狭窄率以及各并发症的发生率，显著高于B组(P<0.05)结论：糖鉍病合并AMI临床特点存在隐匿性，误诊率高，临床上应该对于可疑病例进行密切观察，治疗上采用糖尿病与心肌梗死治疗方案相结合的策略。【关键词】糖鉍病合并急性心肌梗死(AMI);临床特点；误诊原因；对策分析[Ab
3、stract]Objective：tostudytheclinicalfeatures,misdiagnosiscausesandcountermeasuresofacutemyocardialinfarction(AMI)withdiabetes.Methods：FromMay2009toMay2013,therewere156patientswhowerediagnosedwitheitherAMIwithdiabetesorAMIwithoutdiabetes.Theywereequallydividedinto2groups.Discussionsweremadeonth
4、etwogroupsintermsoftheirclinicalfeatures,misdiagnosiscausesandcountermeasures.Results：TheamountsofGLU,TG,HDLconcentrationsofgroupAweresignificantlyhigherthanthoseofcontrolgroup,namely，groupB(P<0.05).AsforpatientsingroupA,themainclinicalsymptomswerepressingchestpain,difficultbreathing，gastr
5、ointestinalreaction，andepigastricpain，ofwhichtheoccurencerateswererespectively41%,23.1%,12.8%,14.1%,higherthanthoseofgroupB(P<0.05).Inthemeantimetheoccurrenceratesofdiffusingcoronaryarteryandheavyarteriarctiawererespectively52.6%,50%，whichwereofsignificantdifferenceswhencomparedwithgroupB(
6、P<0.05)；andgroupBhadthetimeoftypicalmyocardialinfarction-6:00-13:59.TheoccurrencerateofgroupBwas53.8%,wasmuchhigherthanthecorrespoundingtimeofgroupA(P<0.05).Moreover，themisdiagnosisrate，mortality，ratesofrestenosisaftertreatmentaswellastheincidenceofcomplicationsweresignificantlyhigherth
7、anthoseofgroupB(P<0.05).Conclusions:SinceAMIwithdiabetesisoflatentclinicalfeatures，itsmisdiagnosisrateishigh.Inclinicalpractice，closeobservationsshouldbeplacedonsuspectedcases，andthetreatmentstrategyshouldcombinetherapeuticregimenfordiabet
