老年急性心肌梗死患者应激激素和血糖水平变化及其对预后的影响  

Alterations of stress hormone and glucose level and their prognostic value in senile patients with acute myocardial infarction

作　　者：李英梅[1,2] 车在前[3] 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] 宋艳艳[4] 江蓓湖[2] 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,200062 [2]上海中医药大学附属普陀医院老年科,200062 [3]上海交通大学附属瑞金医院急诊科 [4]上海交通大学医学院生物统计学教研室

出　　处：《上海医学》2010年第9期853-856,共4页Shanghai Medical Journal

基　　金：上海市卫生局青年基金资助项目(2006Y063)

摘　　要：目的探讨老年急性心肌梗死患者的应激激素和血糖水平变化及其对预后的影响。方法测定106例非糖尿病老年(≥60岁)急性心肌梗死患者的入院即刻血糖水平,以随机血糖≥7.8mmol/L为应激性高血糖,分为非应激性高血糖组(63例)和应激性高血糖组(43例),对比分析两组的临床资料和皮质醇、生长激素、胰岛素、胰高血糖素、促肾上腺皮质激素(ACTH)水平,及发病30d内心力衰竭、再发心肌梗死、梗死后心绞痛、严重心律失常及因心血管疾病死亡情况。结果应激性高血糖的发生率为40.6%。应激性高血糖组的随机血糖、皮质醇、生长激素、胰高血糖素、ACTH水平均显著高于非应激性高血糖组(P值均<0.01),胰岛素水平显著低于非应激性高血糖组(P<0.01)。应激性高血糖组的心力衰竭、再发心肌梗死、梗死后心绞痛、严重心律失常及因心血管疾病死亡的构成比均显著高于非应激性高血糖组(P值均<0.05)。应激性高血糖组的左心室射血分数(LVEF)为0.4884±0.0737,显著低于非应激性高血糖组的0.5405±0.0624(P<0.05)。结论入院血糖和应激激素异常增高与老年急性心肌梗死患者发病30d内的预后较差相关。Objective To investigate the alterations of stress hormones and glucose level and their prognostic value in senile patients with acute myocardial infarction. Methods A total of 106 non-diabetics patients （≥60 years old） with ST segment elevation myocardial infarction （STEMI） were divided into 2 groups according to serum glucose（SG）levels on admission：Non-stress hyperglycemia group, SG7.8 mmol/L （n=63）, Stress hyperglycemia group,SG≥7.8 mmol/L （n=43）. Stress hyperglycemia was defined as random SG levels greater than or equal to 7.8 mmol/L on admission. We compared the clinical data and stress hormones（Cortisol, growth hormone, Insulin, glucagons, adrenocorticotropic hormone [ACTH]）, and investigated heart failure, reinfarction, post-infarction angina, serious arrhythmias, and cardiac death in the 2 groups. Results The incidence of stress hyperglycemia was 40.6% in the present study.The stress hormone levels in the stress hyperglycemia group were significantly higher than those in the non-stress hyperglycemia group （P0.01）. The insulin level in the stress hyperglycemia group was much lower than that of non-stress hyperglycemia group （P0.01）. The incidences of heart failure, reinfarction, post-infarction angina, serious arrhythmias, and cardiac death in the stress hyperglycemia group were markedly higher than those of non-stress hyperglycemia group （P0.05）. The left ventricular ejection fraction in stress hyperglycemia group was markedly lower than that in the non-stress hyperglycemia group （0.488 4±0.073 7 vs. 0.540 5±0.062 4, P0.05）. Conclusion Aberrantly high blood glucose and stress hormones on admission are associated with a poor prognosis （within 30 days after onset） in senile patients with acute myocardial infarction.

关 键 词：心肌梗死 预后 应激 血糖 激素 

分 类 号：R542.22[医药卫生—心血管疾病]