心力衰竭糖尿病患者急性心肌梗死后无法回避的难题课件.pptVIP

《规范》及指导原则适用于食品药品监管部门对第三类医疗器械批发/零售经营企业经营许可（含变更和延续）的现场核查，第二类医疗器械批发/零售经营企业经营备案后的现场核查，以及医疗器械经营企业的各类监督检查 《规范》及指导原则适用于食品药品监管部门对第三类医疗器械批发/零售经营企业经营许可（含变更和延续）的现场核查，第二类医疗器械批发/零售经营企业经营备案后的现场核查，以及医疗器械经营企业的各类监督检查 心力衰竭 --糖尿病患者急性心肌梗死后无法回避的难题 吴永健 中国医学科学院 中国协和医科大学 心血管病研究所 阜外心血管病医院 糖尿病患者急性心肌梗死后心力衰竭 The prevalence of heart failure is about 12% in people with Type 2 diabetes as compared to only 3.2% in non-diabetic subjects At 6 months, the incidence of HF was 24% (n=10) in the diabetics and 11% (n=30) in the non-diabetics (P=0.015) At 5 years, the rate of HF increased to 43% (n=18) in the diabetics and to 20% (n=57) in the non-diabetics (P=0.001). Heart failure in Type 2 diabetic patients following ACS Circulation 2000;102:1014-1019 CHF event rate (%) 0 5 10 15 20 25 0 3 6 9 12 15 18 21 24 DM+, CVD+ DM-, CVD+ DM+, CVD- DM-, CVD- Months Acute Coronary Syndrome OR (95% CI) P Age, y 1.0513 (1.0284–1.0746) 0.0001 Peak CK, U/L 1.0002 (1.0001–1.0002) 0.0004 Six-month LV dilation, mL 1.0104 (1.0038–1.0170) 0.0021 Diabetes 1.8026 (1.0374–3.1321) 0.0366 Predictors of HF at Multivariate Cox Analysis (6 months) Circulation. 2004;110:1974-1979 糖尿病急性心肌梗死后HF 糖尿病急性心肌梗死后早期HF的机制 糖尿病急性心肌梗死后早期HF的机制 Diabetes and congestive HF independent of CAD Endocrine Reviews 2004;25:543-567 Small vessel disease Diabetic cardiomyopathy Left ventricular dysfunction Cardiac autonomic neuropathy Cardiac insulin resistance 糖尿病急性心肌梗死后晚期HF的机制 Diabetes mellitus can accerate the progression of post-infarction genetic regulatory expression in untreated Streptozotocin-induced Diabetic Rat Model -Genetic findings in the remote zone of LV free wall post acute myocardial infarction Guang-Yuan Song1, Yong-Jian Wu1*, Yue-Jin Yang1, Jian-Jun Li1, Rui Li2, Ru-Tai Hui3, Han-Jun Pei1, Zhen-Yan Zhao1 From the 1Center of Coronary Heart Disease, 3Center of Hypertension, Cardiovascular Institute Fu-Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences , Beijing