应激性高血糖对急诊PCI患者心肌灌注及临床预后的影响  

Influences of stress hyperglycemia on myocardial perfusion and clinical prognosis in patients with emergency PCI

作　　者：李韶南[1] 罗义[1] 李广镰[1] 潘宜智[1] 曾冲[1] 刘震[1] 雷晓明[1] 

机构地区：[1]广州市第一人民医院,广州510180

出　　处：《中国循证心血管医学杂志》2014年第1期44-47,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的：探讨应激性高血糖（SHG）对接受直接经皮冠状动脉介入治疗（PCI）急性ST段抬高心肌梗死（STEMI）患者心肌灌注及临床预后的影响。方法纳入初次发生STEMI并在起病12 h内行直接PCI治疗的非糖尿病患者352例，按入院即刻血糖（SG）水平分为三组：正常血糖组（SG＜7.0 mmol/L）114例；血糖升高组（7.0 mmol/L≤SG≤11.1 mmol/L）128例；高血糖（SHG）组（SG＞11.1 mmol/L）110例。比较三组患者直接PCI后心肌灌注指标包括术后2 h ST段回落（STR），TIMI心肌灌注分级（TMPG）及心肌肌酸激酶同工酶（CK-MB）峰值、术后左室射血分数（LVEF）的差异。PCI后随访12个月，观察并记录三组患者随访期内心脏不良事件（MACEs）的发生情况。结果正常血糖组、血糖升高组、SHG组三组患者随血糖水平升高，术后2h STR良好比例（71.9% vs.53.9%vs.44.5%）及TMPG2-3级比例（70.2%vs.54.7%vs.46.4%），均逐渐降低（P均＜0.05），术后CK-MB峰值逐渐升高（189.2±78.9mmol/L vs.214.6±80.1mmol/L vs.246.5±79.2mmol/L，P＜0.01）且术后7～10天LVEF明显降低，以高血糖组降低最明显[（52.7±7.2）%vs.（50.8±6.7）%vs.（49.1±5.5）%，P＜0.01]。PCI后随访12个月，Kaplan-Meier生存分析发现三组患者累积无MACEs事件生存率差异有统计学意义（89.5%vs.85.9%vs.77.3%，Logrank=7.173，P=0.028），在校正了年龄后，多因素Cox回归分析显示SHG是STEMI患者直接PCI术后MACEs发生的独立预测因子。SHG组患者较正常血糖组患者术后发生MACEs的风险增加3.546倍（RR=3.546，P＜0.01）。结论STEMI患者并发SHG会导致直接PCI再灌注治疗后心肌灌注水平降低，致使心脏不良事件发生率升高，影响患者的临床预后。Objective To investigate the influences of stress hyperglycemia （SHG） on myocardial perfusion and clinical prognosis in patients with acute ST-segment elevation myocardial infarction （STEMI） treated with direct percutaneous coronary intervention （PCI）. Methods Non-diabetic patients （n=352） with initial STEMI treated with direct PCI within 12 h were chosen and divided into 3 groups according to their levels of immediate serum glucose （SG） after hospitalization：normal SG group （SG＆lt;7.0 mmol/L, n=114）, elevated SG group （7.0 mmol/L≤SG≤11.1 mmol/L, n=128） and SHG group （SG＆gt;11.1 mmol/L, n=110）. The indexes of myocardial perfusion were compared among 3 groups, including ST-segment resolution （STR） 2 h after PCI, TMPG, and CK-MB peak value and LVEF. All patients were followed up for 12 months after PCI, and the incidence of MACE was observed and recorded in 3 groups during follow-up period. Results The proportion of better STR （71.9%vs. 53.9%vs. 44.5%） and grade 2 or grade 3 TMPG （70.2%vs. 54.7%vs. 46.4%） decreased as the increase of SG level in 3 groups 2 h after PCI. CK-MB peak value increased （189.2±78.9 mmol/L vs. 214.6±80.1mmol/L vs. 246.5±79.2 mmol/L, P〈0.01） after PCI, and LVEF decreased significantly [（52.7±7.2）%vs. （50.8±6.7）%vs. （49.1±5.5）%, P〈0.01] 7-10 d after PCI. During 12-month follow-up period, Kaplan-Meier survival analysis showed that the difference in survival rate without accumulated MACE had statistical significance （89.5%vs. 85.9%vs. 77.3%, Logrank=7.173, P=0.028）. After adjusting age, multi-factor Cox regression analysis showed that SHG was an independent predictive factor of MACE in STEMI patients after direct PCI. The risk of MACE was 3.546 times higher in SHG group than that in normal SG group （RR=3.546, P〈0.01）. Conclusion STEMI combined with SHG will directly induce the decrease of myocardial perfusion level, higher incidence of MACE and poor clinical prognosis after direct PCI.

关 键 词：应激性高血糖 血管成形术 经皮 心肌梗死 预后 

分 类 号：R587.1[医药卫生—内分泌]