不同入院血糖水平对ST段抬高的急性心肌梗死患者近期病死率的影响  

Effect of admission blood glucose levels on the short term mortality in patients with acute ST-segment elevation myocardial infarction

作　　者：杨艳敏[1] 刘尧[1] 朱俊[1] 谭慧琼[1] 梁岩[1] 丽英[1] 李建冬[1] 章晏[1] 刘力生[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院急症抢救中心,100037

出　　处：《中华医学杂志》2009年第18期1230-1233,共4页National Medical Journal of China

摘　　要：目的探讨ST段抬高的急性心肌梗死（STEMI）患者入院时不同血糖水平与近期病死率的相关性。方法观察性分析国际性随机对照临床试验中7446例出现症状12h内STEMI的中国患者以入院血糖水平分成6组，分别为入院血糖水平〈4．5mmol／L组（血糖偏低组），血糖水平4．5～5．5mmol／L组，5．6—7．0mmol／L组，7．1～8．5mmol／L组（血糖轻度升高组）和8．6～11．0mmol／L组（血糖中度升高组），血糖〉11．0mmol／L组（高血糖组）。分析6组患者30d的病死率。以血糖水平4．5～5．5mmol／L组作为对照组，与其他血糖水平组进行比较。结果高血糖组病死率（18.6％，P=0．01）比血糖水平4．5～5．5mmol／L组，血糖偏低组（10．2％，P=0．018）、血糖轻度升高和中度升高组（9．2％，P=0．01；11．6％，P〈0．01）均明显升高。多因素Logistic回归分析显示血糖轻度和中度升高组（7．1—8．5mmol／L和8．6—11．0mmol／L）死亡危险分别比正常血糖患者增加46％（OR1．46，95％CI，1．03～2．07，P=0．01）和58％（OR1．58，95％CI1．13～2．22，P=0．02），高血糖组死亡危险比正常血糖患者增加126％（OR2．26，95％CI1．62～3．14，P〈0．01）。入院血糖偏低、轻中度升高和高血糖是30d病死率的独立危险因素。结论入院血糖偏低、轻中度血糖升高和高血糖的STEMI患者近期病死率均明显升高。血糖水平是与STEMI患者近期预后相关的重要因素。Objective To evaluate the predictive value of different admission blood glucose levels for short-term mortality in patients with ST-segment elevation acute myocardial infarction （STEMI）. Method An observational analysis of 7446 Chinese STEMI patients from a global randomized controlled trials were recruited within 12 hours of symptom onset. According to the levels of admission glucose ,these patients were divided into six groups, admission glucose 〈4.50 mmol/L was defined as the hypoglycemia group; glucose of 4. 5 - 5.5 mmol/L a control; 5.6 - 7. 0 mmol/L, 7.1 - 8. 5 mmol/L （ mild hyperglycemia group） and 8. 6- 11.0 mmol/L （moderate hyperglycemia group ）; glucose 〉 11.0 mmol/L was the severe hyperglycemia group. The 30-day mortality was analyzed. Result Compared with the glucose of 4.5 - 5.5 mmol/L group, thirty-day mortality increased in patients with hypoglycemia （ 10. 2% ,P 〈 0. 05 ）, mild and moderate hyperglycemia （9.2% , P = 0. 01 ; 11.6%, P 〈 0. 01, respectively） and severe hyperglycemia （ 18. 6% ,P 〈0. 01 ）. The highest mortality occurred in the severe hyperglycemia group. Multivariate logistic regression analysis showed that, as compared with glucose of 4.5 - 5.5 mmol/L, the mild and the moderate hyperglycemia groups had a mortality increasing of 46% （ OR 1.46,95% CI 1.03 - 2. 07 ,P = 0. 01 ） and 58% fold （OR 1.58,95% CI 1.13 -2. 22 P = 0. 02） respectively; the severe hyperglycemia group had a risk of death of 2. 26 folds （ OR 2. 26,95% CI 1.62 - 3.14, P = 0. 05 ） . Mild, moderate and severe hyperglycemia were independent predictors of 30-day mortality. Conclusion The 30-day mortality was higher in STEMI patients with mild, moderate and severe hyperglycemia at admission. Admission blood glucose level is an important factor associated with a short-term.

关 键 词：心肌梗死 高血糖症 低血糖症 

分 类 号：R686[医药卫生—骨科学]