糖代谢异常对急性冠脉综合征患者远期预后的影响  

Influence of Abnormal Glycometabolism on Long-Term Prognosis in Patients with Acute Coronary Syndrome

作　　者：叶永刚[1] 蒋利[1] 徐颖杰[1] 岳静雯[1] 朱频[1] 

机构地区：[1]上海市长宁区中心医院心内科,上海200336

出　　处：《中国临床医学》2013年第3期289-291,共3页Chinese Journal of Clinical Medicine

基　　金：上海市卫生局科技发展基金资助(编号:054111)

摘　　要：目的:研究糖代谢异常对急性冠脉综合征(acute coronary syndrome,ACS)患者远期预后的影响。方法:选择2007年1月—2010年6月收治的453例ACS住院患者,根据糖尿病病史及口服糖耐量试验(oral glucose tolerance test,OGTT)结果分为4组:血糖正常组(n=132)、空腹血糖受损(impaired fasting glucose,IFG)组(n=81)、糖耐量受损(impaired glucose tole-rance,IGT)组(n=89)、糖尿病(diabetes mellitus,DM)组(n=151),定期电话或临床随访患者远期预后情况,包括心肌梗死、血运重建、病死等主要心血管不良事件(major adverse cardiac events,MACE)。结果:与血糖正常组相比,IGT组和DM组无事件中位生存时间明显缩短(P均<0.05),而IFG组差异无统计学意义(P>0.05)。与血糖正常组(27.27%)相比,IGT、DM组MACE发生率均明显增加(44.94%,49.01%;P值均<0.05);而IFG组与血糖正常组比较,MACE发生率差异无统计学意义(32.10%,P>0.05)。Cox回归分析显示,男性、年龄、吸烟、血脂异常、糖代谢异常、血运重建史是发生MACE的独立危险因素。结论:ACS患者中合并IGT或DM者远期预后较血糖正常者差,对于此类患者需定期监测其血糖代谢情况。Objective：To investigate the influence of abnormal glycometabolism on long-term prognosis of patients with acute coronary syndrome （ACS）. Methods： A total of 453 patients with ACS from January 2007 to June 2010 were divided into 4 groups according to history of diabetes mellitus and results of oral glucose tolerance test （OGTT）： normal plasma glucose group （132 cases）, impaired fasting glucose （IFG） group （81 cases）, impaired glucose tolerance （IGT） group （89 cases）, and diabetes mellitus （DM） group （151 cases）. All of them have been followedup by phone or clinical interview periodically for long-term prognosis of patients, including major adverse cardiac events （MACE） of myocardial infarction, revascula-rization and death, etc. Results： Compared with normal plasma glucose group, the non-event median survival time in IGT and DM group were significantly shortened （both P〈0.05）. However, no statistical significance was found between IFG group and normal plasma glucose group （P〉0.05）. Compared with normal plasma glucose group（27.27%）, the incidences of MACE were significantly higher in IGT group and DM group （44.94%, 49.01%, both P〈0.05）, but no statistical significance was found between IFG group and normal plasma glucose group （32.10 %, P〉0.05）. Cox regression analysis showed that male, age, smoking, dyslipidemia, abnormal glycometabolism and revascularization were independent risk factors for the occurrence of MACE. Conclusions： ACS patients with IGT or DM have poorer long-term prognosis than whom with normal plasma glucose and need to be monitored by OGTT periodically.

关 键 词：急性冠脉综合征 空腹血糖受损 糖耐量受损 远期预后 

分 类 号：R54[医药卫生—心血管疾病]