糖化血红蛋白对合并糖尿病的急性心肌梗死患者PCI术后远期生存的影响  

The prognostic impact of glycated hemoglobin in diabetic patients with acute myocardial infarction

作　　者：徐伟豪 郭文杰[2] 高荣[3] 杨庭树[1] 

机构地区：[1]解放军总医院南楼心一科,北京100853 [2]解放军总医院心血管内科,北京100853 [3]解放军第十医院

出　　处：《中华保健医学杂志》2015年第3期180-184,共5页Chinese Journal of Health Care and Medicine

基　　金："十五"全军医药卫生科研基金课题重点资助项目(01Z036);军队临床高新技术重大项目(2010gxjs093)

摘　　要：目的探讨糖化血红蛋白（Hb A1c）对合并糖尿病的急性心肌梗死（AMI）患者行经皮冠状动脉介入治疗（PCI）术后远期生存的影响作用。方法对解放军总医院心血管内科2004年1月~2004年12月间,确诊为AMI且合并糖尿病,行PCI治疗的患者155例（男性110例,女性45例）进行随访,随访截止日期为2013年12月。采用多因素Cox回归分析影响生存的相关危险因素。根据患者住院治疗期间Hb A1c水平分为正常组Hb A1c 4.7%~6.4%（n=53）,轻微升高组Hb A1c 6.5%~8.4%（n=72）,显著升高组Hb A1c 8.5%~12.4%（n=30）,比较3组患者远期生存率的差异。结果 （1）入选患者PCI术后10年生存率为62.8%,正常组生存率为73.6%,轻微升高组生存率为63.2%,显著升高组生存率为46.4%。（2）3组患者的总体生存曲线比较,差异具有统计学意义（P=0.025）。（3）与合并糖尿病急性心机梗死患者PCI术后远期生存相关的因素包括年龄（每增加10年）HR 1.596,95%CI为1.204~2.115;吸烟HR 2.101,95%CI为1.185~3.725;LVEF（每减少10%）HR 1.463,95%CI为1.112~1.923;服用ACEI或ARB类药物HR 0.514,95%CI为0.268~0.986;Hb A1c（每增加1%）HR 1.283,95%CI为1.009~1.628。结论随着Hb Alc水平的升高,合并糖尿病的AMI患者PCI术后10年生存率明显下降。Objective To assess the prognostic impact of glycated hemoglobin in diabetic patients with acute myocardial infarction. Methods A follow-up study was carried out for diabetic patients with acute myocardial infarction（AMI） who received percutaneous coronary intervention（PCI） treatment in the department of cardiology PLA General Hospital from Jan.2004 to Dec. 2004.A total of 155 patients（110 males and 45 females） were recruited in this study and followed up till Dec.2013. The independent factors of survival were analyzed with Cox regression analysis. According to the Hb A1 c level,patients were divided into 3 groups：normal group Hb A1c4.7% ~ 6.4%（n = 53）,slightly rising group Hb A1c6.5% ~ 8.4% and remarkably rising group Hb A1 c 8.5% ~ 12.4%. The survival rate was compared among the 3 groups. Results（1） The total survival rate of the diabetic patients with AMI after 10 years was62.8%;the normal group was 73.6%;the slightly rising group was 63.2%;the remarkably rising group was 46.4%.（2） There were prominent statistical differences among the survival curves of the 3 groups（P = 0.025）.（3） The age（10 years increasing） HR1.596,95%CI（1.204,2.115）;smoking HR 2.101,95% CI（1.185,3.725）;LVEF（10% decreasing） HR 1.463,95% CI（1.112,1.923）;the use of ACEI or ARB HR 0.514,95% CI（0.268,0.986）;Hb A1c（1% increasing） HR1. 283,95% CI（1.009,1.628）. Conclusion With the increasing of Hb A1 c level,the 10 years survival rate of diabetic patients with acute myocardial infarction decreases significantly.

关 键 词：急性心肌梗死 糖尿病 糖化血红蛋白 生存 

分 类 号：R542.2[医药卫生—心血管疾病]