入院高血糖对急性前壁心肌梗死经皮冠状动脉腔内介入术后左心室重构的影响  

The impact of admission hyperglycemia on left ventricular remodeling for the patients of acute ST-segment elevation anterior myocardial infarction after percutaneous coronary intervention

作　　者：池喆[1] 米树华[1] 张晓霞[1] 关杨[1] 赵全明[1] 吴学思[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所特需医疗科,100029

出　　处：《心肺血管病杂志》2015年第3期202-206,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的：观察入院时高血糖患者对住院期间成功开通梗死相关血管的急性ST段抬高型前壁心肌梗死左心室重构的影响。方法：连续入选我院2009年1月至2010年12月,以急性ST段抬高型前壁心肌梗死,并在住院期间行经皮冠状动脉腔内介入术（PCI）成功开通梗死相关血管（IRA）的患者478例。根据PCI术前入院时随机静脉血血糖值≥7.8mmol/L,分为血糖增高组（AHG）,入院血糖≥7.8mmol/L和正常血糖组（NGT）,入院血糖〈7.8mmol/L）,详细记录患者的基线资料,比较两组患者住院期间临床特征,门诊随诊至出院后6个月至1年。随诊内容包括实验室生化指标、超声心动图及服药情况等。分析入院血糖增高对急性ST段抬高型前壁心肌梗死患者左心室重构的影响。结果：共入选患者478例,424例完成随访,平均随访时间7.5个月。入院高血糖的发生率是44.1%（211/478）。随访结束时,31.6%（134/424）的患者发生心脏扩大。两组患者入院时在左心室舒张末期内径（LVEDD）、Killip分级、左心室扩大比例、早期再灌注、服药治疗等方面,差异无统计学意义（P〉0.05）。随访结束时,与正常血糖组相比,高血糖组LVEDD扩大明显[（54.3±5.0）vs.（52.2±6.7）mm,P〈0.05],心脏扩大比例增高,（38.6%vs.26.2%,P〈0.05）。多因素Logistic回归分析显示：入院高血糖（OR=5.770,95%CI：1.144~3.782,P=0.016）是心脏扩大的独立危险因素。结论：入院高血糖是急性ST段抬高前壁心肌梗死6个月~1年左心室重构的独立危险因素。Objective ： Observation of the impact of admission hyperglycemia on left ventricular remode- ling for the patient of acute ST-segment elevation myocardial infarction （ STEMI ） who had been successfully opened the infarct-related artery during hospitalization. Methods： Consecutively enrolling 478 patients who were accepted by our hospital due to STEMI and delivered PCI during hospitalization to successfully open the infarct-related artery （IRA） from January 2009 to December 2010. According to the criteria of hospitalized ran- dom venous blood glucose ≥7. 8mmol/L before percutaneous coronary intervention, they were divided into hyperglycemia group and normal glucose group （ 〈 7.8mmol/L）. The patient＇s baseline data was recorded in detail. The clinical features of the two groups during hospitalization were compared. Outpatient follow-up continued from 6 months to 1 year after hospital discharge. The follow-up includes laboratory biochemical markers, echocardiography, medication compliance etc. Analyze the impact of admission hyperglycemia on left ventricu- lar remodeling for the patient of acute STEMI. Results： A total of 478 cases of patients enrolled, 424 cases completed the follow-up with complete data. The mean follow-up time was 7.5 months. The admission hyperglycemia incidence was 44. 1% （211/478 ）. When follow-up finished, the enlargement of the heart occurred with 31.6% （134/424） of patients. The difference was not statistically significant in terms of left ventricular end- diastolic internal diameter （LVEDD） , Killip classification, left ventrieular enlargement, early reperfusion and medication therapy for the patients of two groups when admission. At the end of the follow-up, compared with normal glucose group, LVEDD of hyperglycemia group expanded significantly [ （ 54. 3 ± 5.0 ） vs. （ 52. 2 ±6. 7） ram, P 〈 0. 05 ] , the proportion of the heart enlargement increased （ 38.6% vs. 26. 2% , P 〈 0.05 ）, Multivariate logistic regression analysis showed that a

关 键 词：急性心肌梗死 左心室重构 经皮冠状动脉介入治疗 

分 类 号：R54[医药卫生—心血管疾病]