糖化血红蛋白对急性心肌梗死患者预后的影响  

Influence of glycosylated hemoglobin level on the prognosis of patients with acute myocardial infarction

作　　者：李山[1] 罗平[2] 王春梅[2] 朱小玲[2] 刘子军[2] 张利利[1] 

机构地区：[1]北京中医药大学第三附属医院,100029 [2]首都医科大学附属北京安贞医院抢救中心

出　　处：《中华老年心脑血管病杂志》2010年第8期705-707,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的观察糖化血红蛋白(HbA1c)对急性心肌梗死患者预后的影响。方法选择发病时间<12 h、ST段抬高心肌梗死患者541例。根据入院时HbA1c水平分为2组:HbA1 c升高组206例(HbA1c≥6.5%)和对照组335例(HbA1 c<6.5%),分析HbA1c水平对患者预后的影响。结果 2组在年龄、吸烟、前壁急性心肌梗死、发病至就诊时间、冠状动脉造影、再灌注成功率、双支血管病变及住院期间药物治疗方面差异无统计学意义(P>0.05)。HbA1c升高组患者糖尿病、高血压、血糖水平、3支血管病变、住院期间发生心力衰竭、心源性休克及病死率明显高于对照组;男性比例、LVEF及单支血管病变比例明显低于对照组。多因素分析结果显示,HbA1c升高是影响住院期间发生心力衰竭(OR=1.355,95% CI:0.498～2.788,P=0.039)及病死率(OR=0.872,95% CI:0.421～1.733,P=0.041)的独立危险因素。结论 HbA1c水平升高是住院期间发生心力衰竭及病死率的预测因素,应重视HbA1c对判断急性心肌梗死患者预后的作用,指导患者控制血糖,改善预后。Objective To evaluate the influence of glycosylated hemoglobin（HbA1c） level on inhospital outcomes of patients with acute myocardial infarction.Methods The data of 541 inpatients with STelevation myocardial infarction were collected from database of Beijing Anzhen Hospital（n=474） and the Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine（n=67） during January to December 2008.The patients were divided into two groups according to the level of HbA1c：HbA1c≥6.5% group（n=206） and control group（HbA1c〈6.5%,n=335）.The prognosis of two groups were observed.Results Age,smoking,myocardial ischemia time,cases of coronary angiography,the rate of successful reperfusion,drug treatment in hospital showed no significant differences between the two groups（P〉0.05）.Compared with the control group,history of hypertension and diabetes,blood glucose,triplevessel disease,incidence of heart failure,inhospital mortality,cardiogenic shock were increased in HbA1c≥6.5% group,male,LVEF and singlevessel disease were decreased.Logistic analysis showed that HbA1c≥6.5% was independent factor for inhospital fatality（OR=0.872,95%CI：0.421-1.733,P=0.041） and the rate of heart failure（OR=1.355,95%CI：0.498-2.788,P=0.039）.Conclusion The high level of HbA1c is a predictor of inhospital fatality and incidence of heart failure in patients with acute myocardial infarction.Attention should be paid to HbA1c and the prognosis of AMI could be improved by the control of blood sugar.

关 键 词：心肌梗死 血红蛋白A 糖基化 冠状血管造影术 预后 危险因素 

分 类 号：R542.22[医药卫生—心血管疾病]