应激性高血糖对老年急性心肌梗死患者经皮冠状动脉介入治疗后心肌灌注及预后的影响  

Effect of stress-induced hyperglycemia on myocardial perfusion and prognosis in elderly patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

作　　者：李韶南[1] 李广镰[1] 罗义[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心内科,510180

出　　处：《中华老年医学杂志》2015年第6期593-596,共4页Chinese Journal of Geriatrics

摘　　要：目的 探讨老年急性ST段抬高心肌梗死（STEMI）患者并发应激性高血糖（SHG）对急诊经皮冠状动脉介入术（PCI）后心肌灌注水平的影响及与患者临床预后的关系. 方法 回顾性分析2008年6月至2010年6月在我院心内科住院初次发生STEMI并在起病12h内成功行急诊PCI治疗的老年非糖尿病患者348例,按入院即刻血糖水平分为3组：（1）正常血糖组（即刻血糖＜7.0mmol/L） 112例;（2）血糖升高组（7.0 mmol/L≤即刻血糖≤11.1 mmol/L）128例;（3）高血糖组（即刻血糖＞11.1 mmol/L）108例.比较3组患者急诊PCI后心肌灌注指标,包括术后2 hST段回落、心肌梗死溶栓试验心肌灌注血流分级（TMPG）及心肌肌酸激酶同工酶峰值,并随访术后12个月内不良心脏事件（MACE）的发生情况. 结果 3组患者随血糖水平升高,术后2 hST段回落良好和TMPG 2～3级比例均降低（均P＜0.01）;术后肌酸激酶同工酶峰值升高（均P＜0.01）.术后随访12个月,Kaplan-Meier生存分析结果显示,正常血糖组与血糖升高组、高血糖组比较,患者累积无MACE的生存率差异有统计学意义[89.3％（100/112）比85.9％（110/128）、76.3％（83/108）,P＜0.05],在校正了年龄、性别后,多因素Cox回归分析结果显示,SHG是老年STEMI患者直接PCI术后MACE发生的独立预测因子.高血糖组患者较正常血糖组患者术后发生MACE的风险增加5.811倍（P＜0.01）. 结论 老年STEMI患者并发SHG会导致急诊PCI再灌注治疗后心肌灌注水平降低,致使MACE发生率升高.Objective To investigate the effect of stress-induced hyperglycemia （SHG） on myocardial perfusion and clinical prognosis in elderly patients with acute myocardial infarction （AMI） who underwent primary percutaneous coronary intervention （PCI）.Methods 348 elderly patients with first-time occurrence of acute ST-elevation myocardial infarction （STEMI） who underwent primary PCI within 12 hours from June 2008 to June 2010 were enrolled and followed up.All patients were divided into three groups according to serum glucose （SG） on admission：normal group （SG〈 7.0 mmol/L,n=112）;SG elevation group （7.0 mmol/L≤SG≤11.1 mmol/L,n=128） and （steady high blood glucose） SHG group （SG〉11.1 mmol/L,n=108）.Myocardial perfusion indexes,including ST segment resolution （STR）,TIMI myocardial perfusion grade （TMPG）,peak value of creatine kinase CK-MB,left ventricular ejection （LVEF）,and major adverse cardiac events （MACE） of patients in three groups,were measured and compared after emergency PCI.Results The blood glucose levels were increased,ST-elevation 2 h after PCI were well declined,the percentages of patients with TMPG 2-3 were decreased and peak values of CK-MB were increased in the three groups （all P〈0.01）.After 12 months of follow-up,Kaplan-Meier survival analysis showed that patients of three groups had significantly different cumulative non-events survival rates [89.3% （100/112） vs.85.9% （110/128）,76.3% （83/108）,P〈0.05].Multivariate Cox regression analysis showed that steady high blood glucose were the independent predictor for the occurrence of MACE in patients undergoing PCI after adjusting for age and gender,and the risk of MACE was increased by 5.811 folds in SHG group as compared with normal group （P〈0.01）.Conclusions Stress induced hyperglycemia in elderly patients with STEMI can decrease myocardial perfusion level after primary PCI,which will lead to high incidence of MACE.

关 键 词：高血糖症 心肌梗死 血管成形术 经腔 经皮冠状动脉 预后 

分 类 号：R542.22[医药卫生—心血管疾病]