强化降糖及强化他汀治疗对急性心肌梗死伴高血糖患者住院期间心功能影响  

Effect of intensive glycemic and statin treatment on in-hospital cardiac function for patients with acute myocardial infarction and hyperglycemia

作　　者：叶小钧[1] 王勇[1] 黎娜[1] 张丽芳[1] 刘晓飞[1] 陈丽[1] 罗荷[1] 

机构地区：[1]中日友好医院心内科,北京100029

出　　处：《中日友好医院学报》2013年第5期266-271,共6页Journal of China-Japan Friendship Hospital

基　　金：院级重点课题2010-ZD-09

摘　　要：目的:探讨急诊经皮冠状动脉介入治疗术后早期强化血糖管理(IGC)及强化他汀(IS)治疗能否减少急性心肌梗死(AMI)合并高血糖或糖尿病患者院内心衰的发生及可能机制。方法:87例患者随机分为IGC及常规血糖管理(CGC),组内再分为IS及常规他汀(CS)治疗,即IGC+IS(A组),IGC+CS(B组),CGC+IS(C组),CGC+CS(D组)。所有患者于入院即刻、24h、72h及7d检测B型利钠肽(BNP)、高敏C反应蛋白(hs-CRP)同时评估心功能Killip分级。结果:入院24h平均血糖IGC较CGC组显著降低(8.62±1.06和11.64±1.38mmol/L,P<0.01)。Killip分级在72h及7d时IGC较CGC组显著改善、IGC及IS组72h时BNP水平显著降低。心衰持续存在或进展的比率A组均低于其余3组(P<0.05)。IGC及IS可降低各时间点hs-CRP,且A组hs-CRP水平显著低于其余3组(均P<0.01)。结论:早期强化降糖及强化他汀治疗可减少住院期间心衰的发生,联合治疗优于单一强化降糖或强化他汀治疗,推测机制与两者的协同抗炎相关。Objective：To examine whether intensive glycemic control（IGC） and intensive statin（IS） immediately after PCI could reduce the incidence of heart failure in-hospital for hyperglycemic patients with acute ST elevation myocardial infarction （STEMI） and associated mechanisms.nethods：A total of 87 subjects suffering STEMI with blood glucose≥11.1mmol/L were randomized to receive insulin infusion for at least 24h（IGC）or conventional glycemic control（CGC）,then was stratified into conventional statin（CS ：20mg/d atorvastatin）and IS group（80mg/d for 7 days）,so we achieved four groups：IGC＋IS（A）,IGC＋CS（B）,CGC＋IS（C）and CGC＋CS（D）. Hs-CRP,BNP level and cardiac function Killip classification were assessed immediately and 24h,72h and 7 days after admission.Results：Mean 24h glucose level was greater in the CGC than in IGC group（8.62±1.06 vs 11.64±1.38mmol/L,P〈0.01）.Lower Killip class was seen in IGC than CGC group on 72h and 7d （Pr〉F 0.003,0.01）,72h BNP level difference between IGC and CGC,IS and CS was significant.In group A,the incidence of Killip class〉I and Killip class I on admission then worsening to Killip class〉I in the following days decreased significantly compared with B,C,D group （P〈0.05）.The level of hs-CRP reduced significantly in all time point in ICG and IS group,and were lower in group A than in group B,C,D,respectively.Conclusion： Optimal early IGC or IS treatment may improve cardiac function during hospital,their combination results more benefits than either IGC or IS,associated mechanisms may contribute to synergistic anti-inflammatory effect.

关 键 词：急性心肌梗死 心功能 炎症因子 他汀 胰岛素治疗 

分 类 号：R542.22[医药卫生—心血管疾病]