血糖波动在老年糖尿病患者急性心肌梗死早期的临床特点及意义  

Characteristics and clinical significance of blood glucose fluctuations in elderly diabetic patients hospitalized for acute myocardial infarction

作　　者：刘挺松[1] 陈一天[1] 江时森[1] 宫剑滨[1] 

机构地区：[1]中国人民解放军南京军区南京总医院心脏内科,江苏省南京市210002

出　　处：《实用老年医学》2013年第5期390-392,408,共4页Practical Geriatrics

基　　金：中国博士后科学基金面上项目(201150M1570)

摘　　要：目的观察因急性心肌梗死住院的老年糖尿病患者入院早期血糖波动状况并探讨其临床意义。方法采用连续性血糖监测系统(CGMS)连续观察98例老年糖尿病患者急性心肌梗死早期血糖波动情况,记录并比较其住院期间降糖药物使用情况、血糖波动指标和心源性并发症发生率的差异。收集同期因急性心肌梗死住院的108例中青年糖尿病患者作为对照。结果在降糖药物使用无显著差异的情况下,老年糖尿病患者入院早期血糖波动较中青年患者显著恶化,其中日内血糖波动指标血糖水平标准差(SDGB)、最大血糖波动幅度(LAGE)和平均血糖波动幅度(MAGE)均明显升高(P均<0.01),日间血糖波动指标日间血糖平均绝对差(MODD)亦显著升高(P<0.01)。急性心肌梗死早期严重血糖波动的老年患者院内恶性心律失常、心源性休克发生率较轻微血糖波动及中青年组患者均显著升高(P均<0.01)。结论老年糖尿病患者急性心肌梗死早期血糖较中青年患者剧烈波动,且随着血糖变异性的增加,其院内预后亦呈恶化趋势。Objective To observe continuous glucose fluctuations during early phase of acute myocardial infarction(AMI) in elderly diabetic patients and explore the relevant clinical significance.Methods Ninety-eight diabetic patients hospitalized for AMI underwent continuous glucose measurement via CGMS.108 non-elderly diabetic AMI patients were enrolled as control.Results No significant difference was found in terms of administration of hypoglycemic agents.Elderly patients had a marked blood glucose fluctuations compared with non-elderly patients.There were significant difference between two group in four CGMS parameters:SDBG(2.88±0.68 vs 0.85±0.38,P<0.01),LAGE(8.2±2.8 vs 3.9±1.2,P<0.01),MAGE(5.5±2.1 vs 2.8±1.2,P<0.01)and MODD(2.6±1.1 vs 1.2±0.7,P<0.01).Compared with non-elderly patients and elderly patients with mild blood glucose fluctuations,elderly patients with severe blood glucose fluctuations were more likely to suffer from malignant arrhythmia(28.8% vs 13.0%,11.1%,P<0.01)and cardiogenic shock(25.0% vs 10.9%,9.3%,P<0.01)during hospital stay.Conclusions Elderly diabetic patients have marked blood glucose fluctuations during the early phase of AMI,which is associated with a poorer in-hospital prognosis.

关 键 词：血糖波动 心肌梗死 老年人 连续性血糖监测系统 

分 类 号：R587.1[医药卫生—内分泌] R542.22[医药卫生—内科学]