急性心肌梗死伴应激性高血糖患者应用胰岛素的临床观察  

Insulin therapy of patients with acute myocardial infarction complicated with hyperglycaemia:a clinical observation

作　　者：杨晓燕[1] 承解静[1] 王丽敏[1] 杨洁[1] 汪蔚青[1] 李英梅[1] 孙仲伦[1] 沈江帆[1] 康向东[1] 金惠根[1] 

机构地区：[1]上海中医药大学附属普陀医院急诊科,200062

出　　处：《上海医学》2008年第6期385-387,共3页Shanghai Medical Journal

摘　　要：目的观察急性心肌梗死(AMI)伴应激性高血糖患者进行胰岛素治疗的临床疗效。方法76例AMI伴应激性高血糖患者随机均分为治疗组和对照组,分别在治疗前和治疗后第7天抽取静脉血,测定空腹血糖、血清肿瘤坏死因子(TNF)-α、核因子(NF)-κB和C-反应蛋白(CRP),并比较两组的临床疗效。结果治疗后,治疗组和对照组的CRP和TNF-α水平均较治疗前显著下降(P值均<0.01)。治疗组的空腹血糖和NF-κB水平较治疗前显著下降(P值均<0.01),而对照组的差异无统计学意义(P值均>0.05)。治疗组总的心脏事件(严重心律失常、心力衰竭、死亡)发生率为7.9%,显著低于对照组的26.3%(P<0.05)。治疗组的住院天数显著短于对照组(P<0.05)。结论胰岛素能抑制AMI合并应激性高血糖患者炎性介质的表达,从而改善其预后。Objective To observe the clinical effectiveness of intensive insulin therapy for patients with acute myocardial infarction （AMI） complicated with hyperglycaemia. Methods A total of 76 sub}eets with AMI accompanied by hyperglycaemia were randomly divided into 2 groups： treatment group and control group. Blood samples were ohtained from ulnar vein before and 6 days after treatment for determination of tumor necrosis factor （TNF）-α and nuclear factor （NF）-kB in serum and C reaction protein （CRP）; the degree of inflammation and the clinical effectiveness were compared between the 2 groups. Results The levels of CRP and TNF-α were decreased in both groups after therapy （all P〈0.01）. The levels of fasting blood glucose and NF-kB in the treat- ment group were decreased after treatment （both P〈0.01）, and there was no significant changes in the control group （both P〉0.05）. The rate of cardiac events （arrhythmia, heart failure and mortality） in the treatment group were significantly lower than that of control group （7. 9% vs 26. 3%, P〈0. 05）. The hospital ,stay of treatment group was significantly shorter than that of the control group （P〈0.05）. Conclusion The study indicate that insulin can inhibit inflammatory response and improve the prognosis of patients with AMI complicated by hyperglycaemia.

关 键 词：急性心肌梗死 应激性高血糖 炎性介质 心脏事件 

分 类 号：R542.22[医药卫生—心血管疾病] R587.1[医药卫生—内科学]