老年高危急性心肌梗死患者高血糖与预后的关系分析  

Relationship of hyperglycemia and prognosis in elderly acute myocardial infarction patients with high risk: a clinical study

作　　者：高远[1] 郭亮[1] 关启刚[1] 于海杰[1] 张海山[1] 李玉泽[1] 田文[1] 贾大林[1] 张月兰[1] 齐国先[1] 孙英贤[1] 

机构地区：[1]中国医科大学附属第一医院心血管内科,沈阳110001

出　　处：《解放军医学杂志》2013年第6期496-500,共5页Medical Journal of Chinese People's Liberation Army

摘　　要：目的评估老年高危急性ST段抬高性心肌梗死（STEMI）患者入院后随机血糖增高与术后心功能、冠脉血流灌注及1年预后之间的关系。方法连续入选2010年2月-2011年10月在中国医科大学附属第一医院治疗的急性STEMI患者137例,SYNTAX评分≥23分,年龄≥75岁,均接受经皮冠状动脉介入（PCI）治疗,根据入院后随机血糖分为高血糖组69例（随机血糖≥11mmol/L）及对照组68例（随机血糖〈11mmol/L）,回顾性分析两组患者手术前后心功能,术后冠脉血流情况及血清脑钠肽（BNP）、超敏C反应蛋白（hs-CRP）水平,随访术后12个月主要心脏不良事件（MACE）发生情况。结果与对照组比较,高血糖组术后左室射血分数（LVEF）明显降低（42.64%±5.29%vs 54.13%±4.31%,P=0.031）,BNP水平明显增高（619.53±145.77ng/L vs 489.46±159.63ng/L,P=0.035）,hs-CRP水平亦明显增高（26.71±11.28mg/L vs 17.89±9.03mg/L,P=0.023）,术后靶血管血流TIMI≤2级者所占比较较高（13.94%vs 2.94%,P=0.030）。术后12个月高血糖组MACE发生率（19.35%）明显高于对照组（10.29%,P=0.031）。COX比例风险回归模型分析结果显示,年龄（HR=1.03,95%CI 1.001~1.043,P=0.009）、症状出现到就诊时间（HR=1.74,95%CI 1.005～2.102,P=0.039）、KILLIP≥2级（HR=2.02,95%CI 1.004~2.871,P=0.010）、SYNTAX评分（HR=2.88,95%CI 1.105~2.906,P=0.008）、高血糖（HR=2.09,95%CI=1.011～2.439,P=0.014）均为术后12个月MACE发生的独立预测因素。结论入院随机血糖增高的高危老年STEMI患者PCI术后心功能及冠脉血流灌注差,术后12个月MACE发生率较高。Objective To assess the influence of post-admission random hyperglycemia of elderly patients suffering from acute myocardial infarction （STEMI） with elevation of ST segment on cardiac function, coronary perfusion, and the prognosis of one year later. Methods A total of 137 STEMI patients aged over 75 years were enrolled in present study, including 69 cases of random blood glucose ≥ 1 lmmol/L （hyperglycemia group） and 68 cases of random blood glucose 〈 1 lmmol/L （control group）. All the subjects underwent percutaneous coronary intervention （PCI）. The cardiac function before and after operation, postoperative coronary blood flow, serum brain natriuretic peptide （BNP） and hypersensitive C reactive protein （hs-CRP） values of all the patients were retrospectively analyzed. Patients were followed up for major adverse cardiac events （MACE） within 12 months after operation. Results After operation, the left ventricle ejection fraction （LVEF） was significantly lower in hyperglycemia group than that in control group （42.64% ± 5.29% vs 54.13% ± 4.31%, B=0.031）, the BNP and hs-CRP levels were significantly higher in hyperglycemia group than that in control group （619.53 ± 145.77ng/L vs 489.46± 159.63ng/L, P=0.035 26.71 ± 11.28mg/L vs 17.89± 9.03mg/ L, P=0.023）. The proportion of target coronary blood flow TIMI ≥ 2 was relatively higher, and the incidence of MACE in 12 months of follow-up was also higher in hyperglycemia group compared with that in control group （13.94% vs 2.94%, P=0.030; 19.35% vs 10.29%, P=0.031）. Cox proportional hazards regression model showed that age （HR=I.03, 95% CI 1.001-1.043, P=0.009）, symptom to door time （HR=l.74, 95% CI 1.005-2.102, P=0.039）, KILLIP ≥2 （HR=2.02, 95% CI 1.004-2.871, P=0.010）, SYNTAX score （HR=2.88, 95% CI 1.105-2.906, P=0.008）, hyperglycemia （HR=2.09, 95% CI 1.011-2.439, P=0.014） were the independent predictors of 12 months MACE. Conclusion Elderly high risk STEMI patients with admission hyperglycemia ha

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 高血糖症 

分 类 号：R543.31[医药卫生—心血管疾病]