入院血糖水平对ST抬高急性心肌梗死预后的影响  

The impact of admission blood glucose level on the prognosis of ST-segment elevation myocardial infarction

作　　者：刘尧[1] 杨艳敏[1] 朱俊[1] 谭慧琼[1] 梁岩[1] 刘力生[1] 丽英[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：《中华内科杂志》2009年第6期465-468,共4页Chinese Journal of Internal Medicine

摘　　要：目的探讨入院时血糖水平对ST段抬高急性心肌梗死（STEMI）患者30d死亡和主要心血管不良事件（MACE）发生率的预测价值。方法对7446例12h内STEMI患者以入院时不同的血糖水平和有否糖尿病史分成4组（高血糖定为入院血糖〉10mmol／L），Ⅰ组：无糖尿病史且血糖正常组（对照组）；Ⅱ组：有糖尿病史但血糖正常组；Ⅲ组：无糖尿病史但高血糖组；Ⅳ组：有糖尿病史且高血糖组。结果入院高血糖两组患者30d病死率和MACE的发生率明显高于对照组（病死率Ⅰ组8．6％比Ⅲ组17．1％、Ⅳ组18．6％；MACEⅠ组21．6％比Ⅲ组36．3％、Ⅳ组38．8％；P值均〈0．001）。Ⅱ组与对照组相比，30d病死率没有明显增加（11．6％比8．6％，P=0．096）。多因素回归分析显示Ⅲ、Ⅳ组的死亡危险分别为Ⅰ组患者的1．51倍（P〈0．001）和1．83倍（P〈0．001）；入院血糖水平是30d死亡的独立危险因素，血糖水平每升高1mmol／L，病死率增加5％（OR1．05，95％CI1．04～1．07，P〈0．001），而糖尿病史对30d病死率不具有独立预测价值（OR1．11，95％CI0．87～1．42，P=0．412）。结论入院高血糖STEMI患者30d病死率和MACE的发生率显著高于入院血糖正常者，入院高血糖为近期预后不良的独立危险因素，糖尿病史与近期病死率并无明显相关性。Objective To evaluate the predictive value of admission blood glucose level for the mortality within 30-day and major adverse cardiac events （MACE） rate in patients with ST-segment elevation acute myocardial infarction （STEMI）. Methods An observational analysis of 7446 Chinese STEMI patients from a global randomized controlled trials of eases recruited within 12 hours of symptom onset was carried out. According to the levels of admission glucose （hyperglycemia was defined as admission glucose 〉 10 mmol/L） and known diagnosis of diabetes mellitus （DM） ,these patients were divided into four groups, Ⅰ ： no DM and normal glucose group （ control group） ; Ⅱ ： DM but normal glucose group; Ⅲ = no DM and hyperglycemia group; and Ⅳ： DM and hyperglycemia group. Results Admission hyperglycemia was associated with a significantly higher 30-day mortality rate （group Ⅲ 17. 1% vs group Ⅰ 8. 6% ,group Ⅳ 18. 6%vs group Ⅰ 8.6%, P 〈0.001 ） and also an increased incidence of MACE （group Ⅲ 36. 3% vs group Ⅰ 21.6%, group Ⅳ 38.8% vs group Ⅰ 21.6%, P 〈 0. 001 ）. However, DM without admission hyperglycemia did not increase the 30-day mortality （ group Ⅱ 11.6% vs group Ⅰ 8.6%, P = 0. 096）. Multivariate logistic regression analysis showed that compared with group Ⅰ patients, group Ⅲ and group Ⅳ had a risk of death of 1.51 fold（ OR 1.51,95% CI 1.22-1.87 ,P 〈 0. 001 ） and 1.83 fold（ OR 1.83,95% CI 1.40-2. 39,P 〈 0. 001 ）respectively; hyperglycemia was an independent predictor of 30-day mortality and an increase of 1 mmol/L in glucose level was associated with a 5% increase of mortality risk （ OR 1.05,95% CI 1.04-1.07,P 〈0. 001）, but DM without hyperglycemia was not so （OR 1.11,95% CI 0. 87-1.42, P = 0. 412）. Conclusions The rates of 30-day mortality and cardiovascular events are significantly higher in STEMI patients with acute hyperglycemia than in patients without. Hyperglycemia on admission is an independent risk factor for the short-term ou

关 键 词：高血糖症 心肌梗死 糖尿病 预后 

分 类 号：R686[医药卫生—骨科学]