急性心肌梗死早期血清胰高血糖素和胰岛素对血糖水平的影响  

Impact of serum glucagon and insulin on serum glucose at the early phase of acute myocardial infarction

作　　者：赵志刚[1] 陈灵[1] 潘雄[2] 毛泽春[3] 申群喜[3] 

机构地区：[1]深圳市第二人民医院中西医结合分院内科,广东深圳518000 [2]深圳市第二人民医院中西医结合分院检验科,广东深圳518000 [3]深圳市第二人民医院中西医结合分院核医学科,广东深圳518000

出　　处：《中国急救医学》2012年第12期1083-1087,共5页Chinese Journal of Critical Care Medicine

基　　金：深圳市科技计划项目（201003030）

摘　　要：目的探讨急性心肌梗死（AMI）糖代谢正常患者发病早期血清胰高血糖素和胰岛素对血糖水平的影响及临床意义。方法本研究是一项前瞻性队列观察研究。收集我院2010-06-01-2011-06-01急诊科诊治的AMI糖代谢正常患者（年龄〉14岁）为研究对象。根据急诊科首次随机血糖水平，患者被分为高血糖（HG）组（血糖≥7．8mmol／L）和非高血糖（NHG）组（血糖〈7．8mmol／L），比较两组胰高血糖素和胰岛素抵抗指数等指标。结果本研究纳入59例AMI患者，49．2％（29例）合并应激性高血糖。观察急诊科血清胰高血糖素、胰岛素抵抗指数、ST段抬高性心肌梗死比例及肌钙蛋白I峰值指标，HG组和NHG组比较差异有统计学意义（P〈0．05）。结论约半数AMI患者在发病早期合并应激性高血糖。AMI早期急性胰岛素抵抗严重，胰高血糖素明显升高，二者是导致AMI应激性高血糖的重要原因之一。AMI合并应激性高血糖提示患者心肌坏死相对较重；急性期应激性高血糖与患者不良预后相关。Objective Stress - induced hyperglycemia at the acute phase of acute myocardial infarction （AMI） is common and associated with an increased risk of poor outcomes. The aim of this study is to determine the impact of serum glucagon and insulin on serum glucose at the early phase of AMI. Methods This is a prospective cohort study. Consecutive patients （ age 〉 14 years ） with AMI and normal glycometabolism managed in the emergency department （ED） between June 1, 2010 and June 1, 2011 were eligible for inclusion. Patient population was divided into two groups according to initial random serum glucose at the E D： hyperglycemia（ HG , serum glucose ≥7.8 mmol/L） and non - hyperglycemia（ NHG, serum glucose 〈 7.8 mmol/L）. Serum glucagon （ SG）, insulin resistance index （IRI）, and other variables between two groups were compared. Results 59 patients were enrolled in the study, of whom, 49.2% （29） were categorized as stress - induced hyperglycemia. SG, IRI, maximum cardiac troponin I , and the proportion of ST - elevation myocardial infarction were Significant differences in variables between HG and NHG group （ P 〈 0. 05 ） . Conclusion Stress - induced hyperglycemia is encountered nearly in a half of patients with AMI at the early phase of acute myocardial infarction. One of the paramount reasons for stress - induced hyperglycemia is hyperglucagonemia and acute insulin resistance. Hyperglycemia may be a mark of more extensive myocardial damage.

关 键 词：急性心肌梗死(AMI) 血糖 应激 胰高血糖素 胰岛素抵抗 

分 类 号：R587.1[医药卫生—内分泌]