急性心肌梗死患者血糖水平与恶性室性心律失常发生的相关性  

The correlation between blood glucose level and the incidence of malignant ventricular arrhythmias in patients with acute myocardial infarction

作　　者：闫迎川[1] 张凤祥[1] 李小荣[1] 宋桂仙[1] 张健[1] 倪萍[1] 杨兵[1] 陈明龙[1] 曹克将[1] 

机构地区：[1]南京医科大学第一附属医院心脏科,江苏南京210029

出　　处：《中国心脏起搏与心电生理杂志》2011年第3期230-233,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨急性心肌梗死（简称心梗）患者血糖水平与院内发生恶性室性心律失常的关系。方法回顾分析急性心梗临床病例资料1118例，根据人院后空腹血糖水平将心梗患者分为三组：血糖〈6．99mmol／L（A）组，7．00-11．09mmol／L（B）组，≥11．10mmol／L（C）组，按入院时有无糖尿病史分为非糖尿病组和糖尿病组，再将两组按血糖水平（标准相同）分为A1、B1、C1和A2、B2、C2亚组，分析不同组的心血管事件。结果A、B与C组患者数量分别为808例（72．3％），239例，7l例。A、B与C组恶性室性心律失常发生分别是50例（6．2％），19例（7．9％），14例（19．7％），三组之间有显著性差异（P〈0．001）。恶性室性心律失常发生率在非糖尿病组（n=862）A1、B1、C1亚组中分别为5．9％（42例），10．2％（13例）与33．3％（8例），三组之间也有显著差异（P〈0．001），而在糖尿病组中（n=256）恶性室性心律失常发生率分别为8．2％（8例），5．4％（6例）与12．8％（6例），三组之间无显著差异（P=0．277）。多因素logistic回归分析显示非糖尿病心梗患者入院空腹血糖≥11．10mmol／L时院内恶性室性心律失常发生风险最高（OR：6．552，95％CI2．551-16．828，P〈0．001）。结论空腹血糖水平升高（≥11．10mmol／L）增加急性心梗后院内发生恶性室性心律失常风险，尤其在非糖尿病患者中更为明显。Objective To explore the relationship of fasting blood glucose level with malignant ventricular arrhythmias in hospitalized patients suffering from acute myocardial infarction . Methods A total of 1 118 patients with acute myocardil infarction were analyzed retrospectively and assigned into three groups according to the fasting glucose level, glucose level 〈 6.99 mmol/L as group A, glucose level 7.00 - 11.09 mmol/L as group B, and glucose≥ 11.10 mmoL/L as group C. Then they were categorized into non-diabetic group and type 2 diabetic group according to diabetic history. The two groups were assigned into A1 , B1 , C1 and A2 , B2 , C2 subgroups according to the fasting glucose level, and then to analyze their cardiovascular events among the different groups. Results Patients in A, B and C groups accounted for 72.3% （ n = 808 ）, 21.4% （ n = 239）, and 6.4% （ n = 7l ）, respectively. The incidence of malignant ventricular arrhythmias was significantly different among three groups with 6.2% （n =50） ,7.9% （n = 19） and 19.7% （n = 14）, respectively, P 〈 0. 001. This difference was also significant among three subgroups （A1, B1 and C1 group） in the non-diabetic group（5.9% vs 10.2% vs 33.3% ,P 〈0. 001 ）. However, there were no differences among the other three subgroups [ A2, B2 and C2 group） with in the type 2 diahetic group （n = 256） （8.2% vs 5.4% vs 12.8% ,P = 0. 277）. Multiple logistic regression model identified fasting glucose level 〉/11.10 mmol/L within 24 h after admission in non-diabetic patients had the highest risk with in-hospital malignant ventricular arrhythmias in acute myocardial infarction（ OR = 6. 552,95% CI 2. 551 - 16. 828, P 〈 0. 001 ）.Conclusion Elevated fasting glucose （ ≥ 11.10mmol/L） is associated with increased risk of malignant ventricular arrhythmias in acute myocardial infarction and this situation may be more obvious in patients with no history of diabetes mellitus.

关 键 词：心血管病学 血糖 急性心肌梗死 恶性室性心律失常 糖尿病 

分 类 号：R542.22[医药卫生—心血管疾病] R541.7[医药卫生—内科学]