MINOCA合并糖尿病并发恶性心律失常一例并文献复习

MINOCA Complicated with Diabetes and Malignant Arrhythmia: A Case Report and Literature Review

摘要: 目的：报道1例冠状动脉非阻塞性心肌梗死(MINOCA)合并糖尿病并发恶性心律失常患者病历资料，强调糖尿病一级预防及早期治疗对MINOCA患者预后的重要意义。方法：回顾性分析我院确诊1例MINOCA合并糖尿病患者病例资料，以“冠状动脉非阻塞性心肌梗死(MINOCA)”为关键词，检索并复习2016年1月至2021年12月相关文献进行汇总。结果：通过“中国知网数据库”、“万方数据库”、“维普数据库”及“Pubmed数据库”检索出相关文献626篇，符合纳入标准的文献30篇，筛选具有完整病例资料国内外案例33例，本文报道1例，共34例病例资料进行汇总。其中男14例(41.2%)、女20例(58.8%)，男女比例约为1:1.4；年龄(54.4 ± 23)岁，年龄范围23~74岁；病因以冠状动脉痉挛、冠状动脉斑块破裂、冠状动脉血栓形成为主；临床症状以胸痛、胸闷、恶心为主；合并症以高血压为主；吸烟史20例(58.8%)、饮酒史2例(5.8%)；10例(29.4%)急查肌钙蛋白T (1.16 ± 1.15) ng/ml，24例(70.6%)急查肌钙蛋白I (5.51 ± 7.23) ng/ml；10例(29.4%)超声心动图提示心室节段运动异常，16例(47.1%)病例资料包含左室射血分数，其中左室射血分数LVEF ≥ 50% 12例(75%)，LVEF < 50% 4例(25%)；20例(58.8%)心电图ST段抬高，1例(2.9%)束支传导阻滞；5例(14.7%)血脂异常；治疗以抗血小板、调脂、解痉为主。3例(8.8%)患者死亡。结论：积极控制心血管危险因素及早期治疗可有效改善MINOCA患者预后。

Abstract: Objective: This paper reports the medical records of a patient with coronary non-obstructive myocardial infarction (MINOCA) complicated with diabetes mellitus and malignant arrhythmia, emphasizing on the importance of primary prevention and early treatment for the prognosis of MINOCA patients. Methods: The case data of 1 patient diagnosed with MINOCA complicated with diabetes in our hospital were retrospectively analyzed. With “coronary non-obstructive myocardial infarction (MINOCA)” as the keyword, relevant literatures from January 2016 to December 2021 were retrieved and reviewed. Results: Through CNKI database, Wanfang Database, VIP database and Pubmed database, 626 related literatures were retrieved, 30 of which met the inclusion criteria. 33 domestic and foreign cases with complete case data were screened, 1 case was reported in this paper, and a total of 34 cases were summarized. There were 14 males (41.2%) and 20 females (58.8%), with a male to female ratio of 1:1.4. Age: (54.4 ± 23) years, age range: 23~74 years; the main causes were coronary artery spasm, coronary artery plaque rupture and coronary artery thrombosis. The main clinical symptoms were chest pain, chest tightness and nausea. The main complications were hypertension. 20 cases (58.8%) had smoking history and 2 cases (5.8%) had drinking history. Troponin T was (1.16 ± 1.15) ng/mL in 10 cases (29.4%) and Troponin I was (5.51 ± 7.23) ng/mL in 24 cases (70.6%). Echocardiography showed abnormal ventricular segmental movement in 10 cases (29.4%), and the data of 16 cases (47.1%) included left ventricular ejection fraction (LVEF ≥ 50% in 12 cases (75%) and LVEF < 50% in 4 cases (25%)). ST segment elevation in 20 cases (58.8%) and bundle branch block in 1 case (2.9%). 5 cases (14.7%) had dyslipidemia. The main treatment is anti-platelet, lipid-regulating and spasmolysis. Three patients (8.8%) died. Conclusion: Active control of cardiovascular risk factors and early treatment can effectively improve the prognosis of MINOCA patients.