急性ST段抬高型心肌梗死患者入院血糖水平与心功能不全和GRACE评分的相关性分析  

Correlation between admission plasma glucose level and cardiac insufficiency or GRACE scores in patients with acute ST-segment elevation myocardial infarction

作　　者：白玉蓉[1] 靳志涛[2] 鞠鹏[1] 卢鑫[2] 

机构地区：[1]第二炮兵总医院干部病房,北京100088 [2]第二炮兵总医院心内科,北京100088

出　　处：《中国循证心血管医学杂志》2015年第2期232-234,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨急性ST段抬高型心肌梗死(STEMI)患者入院血糖水平与心功能不全和GRACE评分的相关性。方法连续入选2007年1月至2009年12月因STEMI住院的患者244例,收集其人口学信息和临床资料并进行GRACE危险评分。根据入院随机血糖水平分为3组:Ⅰ组(血糖<7 mmol/L,n=102);Ⅱ组(7 mmol/L≤血糖<11 mmol/L,n=102),Ⅲ组(血糖≥11 mmol/L,n=40)。分析其入院随机血糖水平和心功能不全、GRACE危险评分的关系。结果Ⅰ组、Ⅱ组、Ⅲ组患者随着血糖水平升高,女性患者(5.9%vs.17.6%vs.25.0%,P<0.05)及糖尿病患者(8.9%vs.33.3%vs.95.0%,P<0.05)比例增加。Ⅰ组患者心功能不全比例少于Ⅱ组及Ⅲ组(15.7%vs.23.5%vs.25.0%,P<0.05);GRACE评分值低于Ⅱ组及Ⅲ组及Ⅱ组[(148.7±33.1)vs.(160.0±37.6)vs.(171.5±41.2),P<0.05],而Ⅱ组及Ⅲ组心功能不全患者比例及GRACE评分无统计学差异(P>0.05)。相关分析表明入院即刻血糖水平与GRACE危险性评分(r=0.77,P=0.009)和心功能不全(tau_b=0.248,P<0.0001)有显著相关性。结论 STEMI患者入院应激性血糖水平升高与住院心力衰竭和GRACE评分密切相关。无论是糖尿病还是非糖尿病患者,入院即刻血糖水平大于7 mmol/L时心力衰竭发生率明显增加。Objective To investigate the correlation between admission plasma glucose level and cardiac insufficiency or GRACE scores in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods STEMI patients （n=244） were chosen from Jan. 2007 to Dec. 2009, and their demographic information and clinical data were collected and given GRACE risk scoring. All patients were divided, according their admission glucose level, into 3 groups： group I （glucose〈7 mmol/L,n=102）, group II （7 mmol/L≤glucose〈11 mmol/L, n=102） and group III （glucose≥11 mmol/L,n=40）. The relationship between admission plasma glucose level and cardiac insufficiency or GRACE scores was analyzed.Results The percentages of female patients （5.9%vs. 17.6%vs. 25.0%,P〈0.05） and diabetic patients （8.9%vs. 33.3%vs. 95.0%,P〈0.05） increased as the increase of plasma glucose level in 3 groups. In group I, the percentage of patients with cardiac insufficiency was lower than that in group II and group III （15.7%vs. 23.5%vs. 25.0%,P〈0.05）, and GRACE scores were also lower [（148.7±33.1）vs. （160.0±37.6）vs. （171.5±41.2）,P〈0.05]. The percentage of patients with cardiac insufficiency and GRACE scores had no statistical difference between group II and group III （P〉0.05）. Correlation analysis showed that admission plasma glucose level was significantly correlated to GRACE scores （r=0.77,P=0.009） and cardiac insufficiency （tau_b=0.248,P〈0.0001）.Conclusion The stress increase of admission plasma glucose level is closely correlated to admission heart failure and GRACE scores in STEMI patients. When admission plasma glucose level is higher than 7 mmol/L, the incidence of heart failure will increase significantly in patients with or without diabetes.

关 键 词：急性ST段抬高型心肌梗死 随机血糖 心功能不全 GRACE评分 

分 类 号：R541.4[医药卫生—心血管疾病]