| Objective: To compare the myocardial perfusion conditions and the incidence of arrhythmias in patients with CHD and type 2 diabetes who taking glibenclamide or insulin regularly, to assess the adverse effects of glibenclamide on the myocardium, for investigating more effective and rational therapy.Methods: From June, 2008 and December, 2009, 105 consecutive patients (60 male and 45female, age 56.87±8.95 years) who with type 2 diabetes and coronary artery disease were enrolled into the study. All patients had clinical histories of acute myocardial infarction and losed the chance of thrombolysis and emergency PCI; Type 2 Diabetes were diagnosed according to the criterion of WHO; Patients were excluded for any of the following reasons: Insulin-dependent diabetes mellitus; The original severe valvular heart disease, cardiomyopathy, myocarditis, pericarditis, primary pulmonary hypertension; diabetic proliferative retinopathy assessed by an experienced ophthalmologist; diabetic neuropathy assessed by autonomic neuropathy tests or diabetic nephropathy (creatinine>136μmol/L); potential of gastrointestinal bleeding, anemias, and other endocrine or major organ diseases.Each patient was assigned to either insulin or glibenclamide group according to which treatment he accepted outside hospital regularly. The patients who took glibenclamide for group A, insulin for group B and diet for group C. All patients were admitted to hospital and subcutaneous inject low molecula heparin, while oral aspirin, clopidogrel, angiotensin-converting enzyme inhibitor (ACEI), statins, nitrates, If necessary, applied appropriate dose ofβ1-blockers. Collected the clinical informations of all patients in each group detailed, age, sex, body mass index, smoking, drinking, hypertension, hyperlipidemia, electrocardiogram, myocardial enzymes, cardiac troponin I, liver and kidney function, red cell, urine will be normal, blood lipids, blood glucose, glycated hemoglobin, insulin and C-peptide release, a 24-hour urinary albumin excretion, 7 days after myocardial infarction all patients took echocardiography to evaluate the condition of wall motion, ventricular wall thickness, ventricular diameter; 10 days after took selective coronary angiography and PCI, recorded the TIMI rank of the coronary flow lesion count, lesion extent, stents types, etc, took holter in the 3-5 days after operation. one month after PCI all patients took SPECT to evaluate the condition of myocardial perfusion, and ERNA for LVEF; All data are applied SPSS 13.0 for statistical analysis, Normal measurement data express to mean±standard deviation, multiple independent groups was used ANOVA, enumeration data and ranked data usingχ~2 test, with P<0.05 as statistically significant.Results: The three groups in gender, body mass index, smoking, drinking, high blood pressure, blood lipids, glycated hemoglobin, blood glucose, insulin, C-peptide, kidney function, medication, coronary angiography lesions, stents types, etc. connection was no statistical difference. The results of coronary angiography showed that the ratio of the patients with 0.05). The results of Holter showed that the incidence of arrhythmia of the three groups were significantly difference(22.86% vs 48.57% vs 51.54%,χ~2=8.810, P=0.012<0.05), A and B group differences were statistically significant (22.86% vs 48.57%,χ~2=6.341, P=0.012<0.05); A group, C group differences were statistically significant (22.86% vs 51.54%,χ~2 =7.529, P=0.006<0.017), B group, C group no statistically significant difference (48.57% vs 51.54%,χ~2=0.057, P=0.881>0.05). The arrhythmia scores were statistically significant differences between the three groups (10 vs 25 vs 23,χ~2=7.410, P=0.025<0.05), where A, B group the differences were statistically significant (10 vs 25,χ~2=6.991, P=0.008 <0.017), A group, C group differences were statistically significant (10 vs 23,χ~2=5.915, P=0.015<0.017), B group, C group were not statistically significant difference (25 vs 23,χ~2=0.195, P=0.659>0.017). ECT results showed that In the rest state, the ratio of abnormal myocardial perfusion segments in the three groups were statistically significant difference (32.90% vs 25.97% vs 26.15%, P=0.003<0.05); where A, B group were statistically significant difference (32.90% vs 25.97%, P=0.013<0.017); A group, C group were statistically significant difference (32.90% vs 26.15%, p P=0.001<0.017); B group, C group were not statistically significant difference (25.97% vs 26.15%, P= 0.929>0.05); The ischemic myocardial area score A group was significantly higher than B group and C group (380 vs 300, P=0.013<0.017 ), (380vs302, P =0.001<0.017); B group and C group were no significant difference (300 vs 302, P=0.929>0.017). ERNA showed that LVEF in the three groups were statistically significant difference (53%vs(56.51±4.23)% vs 60%,χ~2 =21.479, P=0.000<0.05), A group was significantly lower than B group [53% vs (56.51±4.23)%, P=0.001<0.017]; there were no significant difference between B group and C group [(56.51±4.23)% vs 60%, P=0.033>0.017], A group, C group differences were statistically significant (53% vs 60%,χ~2=4.545, P=0.000<0.017), illustrated the LVEF of A group was significantly lower than B group and C group.Conclusion: 1. The ischemic areas of myocardial perfusion imaging of the patients who had long histories of application of glibenclamide was higher than those of the insulin and diet groups, suggesting that glibenclamide would increase myocardial ischemic area in patients with acute myocardial infarction and type 2 diabetes mellitus, And it would decrease the LVEF severely.2. Glibenclamide had significant adverse effects on TIMI grade of the coronary flow in the patients with acute myocardial infarction and type 2 diabetes mellitus. 3. Glibenclamide increases the possibility of malignant arrhythmias in the patients with acute myocardial infarction and type 2 diabetes mellitus.
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