血清胰高血糖素和胰岛素在AMI早期对血糖水平的影响  

Influence of Serum Glucagon and Insulin on Blood Glucose in Patients with Early Acute Myocar- dial Infarction

作　　者：诸海军[1] 余猛进[1] 方伟敏[1] 孙杰[1] 

机构地区：[1]上海浦东新区人民医院,上海201200

出　　处：《医学临床研究》2013年第10期1968-1970,共3页Journal of Clinical Research

摘　　要：【目的】探讨血清胰高血糖素和胰岛素在急性心肌梗死（AMI）早期对血糖水平的影响。【方法】选取本院急诊科收治的126例AMI急性期患者作为研究对象，根据首次血糖水平将其分为高血糖组（HG组）和非高血糖组（NHG组），分析急诊科血糖、血常规、高敏C反应蛋白（hs-CRP）、心肌肌钙蛋白I（cTnI）、血清胰高血糖素（SG）、胰岛素抵抗指数（IRI）指标的变化情况，比较血清胰高血糖素四分位分组参数，比较急性期与缓解期血糖、SG和IRI的变化。【结果】126例AMI急性期患者中有65（51．59％）例表现为血糖升高；HG组和NHG组比较，两组急诊科AMI白细胞（WBC）、急诊科hs-CRP、cTnI峰值、急诊科血糖、急诊科SG、急诊科IRI指标有统计学差异（P〈0．05）；急性期与缓解期血糖、SG、IRI指标差异有统计学意义；急诊科SG、血糖、IRI、hs-CRP四组间均有统计学差异（P〈0．05）。【结论】约半数患者在AMI早期出现应激性高血糖，其原因可能与AMI早期胰岛素抵抗严重，胰高血糖素迅速增多有关，且AMI发病早期合并高血糖的患者炎症程度，心肌损害程度可能更为严重。[Objective] To explore the influence of serum glueagons（SG） and insulin on blood glucose in patients with early acute myocardial infarction（AMI）. [Methods]Totally 126 patients with AMI at acute phase in emergency department of our hospital were enrolled in the study. According to first blood glucose, all patients were divided into high blood glucose group（HG group） and low blood glucose group（NHG group）. Blood glucose, blood routine examination, high sensitive C-reactive protein（hs-CRP）, cardiac troponin（cTnI）, SG and insulin resistance index（IRI） in acute phase were analyzed. Quartile grouping parameters of SG were compared. The change of blood glucose, SG and IRI between acute phase and remission phase were compared.[Results]Among 126 AMI patients in acute phase, 65 patients（51. 59%） had the elevated blood glucose. There were significant differences in WBC and hs-CRP in emergency department, cTnI peak, blood sugar, SG and IRI in emergency department between HG group and NHG group （ P 〈0. 05）. There were significant differences in blood glucose, SG and IRI between acute phase and remission phase（ P 〈0.05）. There were significant differences in SG at emergency department, blood glucose, IRI and hs-CRP among 4 groups（ P 〈0.05）. [Conclusion]About half of patients in early stage of AMI have the stress hyperglycemia. The reason may be associated with severe insulin resistance and rapid increasing of glucagon in early AMI. Patients with early onset of AMI and high blood glucose may have more severe inflammation and myocardial damage.

关 键 词：心肌梗死 血糖 胰高血糖素 胰岛素 

分 类 号：R542.22[医药卫生—心血管疾病]