急性心肌梗死患者行冠状动脉介入治疗后应激激素与血糖变化及其对预后的影响  

Alteration of stress hormones and glucose levels after percutaneous coronary intervention in patients with acute myocardial infarction and its influence on prognosis

作　　者：李英梅[1] 丘洪[2] 汪蔚青[1] 杨伟[1] 刘宗军[1] 方平[1] 于宏梅[1] 王大英[1] 沈峻[1] 汪志华[1] 孟莉[1] 金惠根[1] 

机构地区：[1]上海中医药大学附属普陀医院心内科,上海200062 [2]上海中医药大学附属普陀医院老年科,上海200062

出　　处：《中国实用内科杂志》2010年第1期61-63,共3页Chinese Journal of Practical Internal Medicine

基　　金：上海市卫生局青年基金(2006Y063)

摘　　要：目的探讨急性心肌梗死(AMI)患者行冠状动脉介入治疗(PCI)后应激激素与血糖变化及其对预后的影响。方法对上海中医药大学附属普陀医院心内科2006年10月至2009年5月收治的115例非糖尿病AMI患者入院即刻血糖进行测定,将其分为无应激性高血糖组68例(A组)和应激性高血糖组(随机血糖≥7.8mmol/L)47例(B组),对比分析两组的临床资料和应激激素变化及30d内心力衰竭、再发心肌梗死、梗死后心绞痛、严重心律失常及心血管死亡情况。结果应激性高血糖的发生率为40.87%;B组应激激素(皮质醇、生长激素、胰高血糖素、ACTH)显著高于A组(P<0.01),而B组胰岛素显著低于A组(P<0.01);AMI急性期B组心力衰竭、再发心肌梗死、梗死后心绞痛、严重心律失常及心血管死亡情况均显著高于A组(P<0.05)。B组左心室射血分数[(49.97±7.21)%]显著低于A组[(54.03±6.34)%](P<0.05)。结论入院血糖与应激激素异常增高和AMI患者PCI术后30d内预后较差相关。Objective Acute myocardial infarction（ AMI） can lead to a series of neuroendocrine changes and results in severe stress, causes critical complications. This study investigates the alteration of stress hormones and glucose levels and its prognostic value after percutaneous coronary intervention （PCI） in patients with acute myocardial infarction. Methods A total of 115 non-diabetics patients with ST elevation MI （STEMI） receiving PCI were divided into 2 groups according to Serum Glucose （SG） levels at admission ： Group A, SG 〈 7.8 mmol/L （ n = 68 ） ;Group B, SG≥7. 8 mmol/L（ n = 47）. Stress hyperglycaemia was defined as random SG level greater than or equal to 7.8 mmol/L on admission. We compared the clinical data and stress hormones and investigated heart failure, reinfaretion, post-infarction angina, serious arrhythmias, and cardiac death in the 2 groups. Results The incidence of stress hyperglycaemia was 40. 87% in our group. The stress hormone levels in group B （cortisol, growth hormone, glucagons, ACTH ） were significantly higher than those in group A（ P 〈 0. 01 ）. The insulin level in group B was significantly lower than that in group A（ P 〈 0. 01 ）. The incidences of heart failure, reinfarction, post-infarction angina, serious arrhythmias, and cardiac death in group B were significantly higher than those in group A （ P 〈 0. 05 ）. LVEF in group B （49. 97 ± 7.21 ） % was much lower than that in group A （ 54.03 ± 6. 34 ） % （ P 〈 0.05）. Conclusion Abnormal increase of blood glucose and stress hormones levels at admission is associated with poor prognosis of AMI patients within 30 days after PCI.

关 键 词：心肌梗死 应激 血糖 激素 

分 类 号：R5[医药卫生—内科学]