糖尿病对急性ST段抬高型心肌梗死患者院内预后的影响  

Impact of diabetes on in-hospital outcomes of patients with acute ST-segment elevation myocardial infarction

作　　者：夏雪[1] 郑再星 朱千里[1] 姜文兵 黄伟剑[1] 

机构地区：[1]温州医科大学附属第一医院心内科,325000 [2]温州市人民医院心内科

出　　处：《心电与循环》2015年第6期443-446,共4页Journal of Electrocardiology and Circulation

摘　　要：目的 分析急性ST段抬高型心肌梗死（STEMI）合并糖尿病患者的临床特征及住院期间预后.方法 对952例急性STEMI患者资料进行回顾性分析,根据是否合并糖尿病分成糖尿病组和非糖尿病组,比较临床特点及住院期间预后.结果 952例急性STEMI患者中187例合并糖尿病.与非糖尿病组比较,糖尿病组女性比例较高,吸烟者少,合并慢性肾功能不全及并发肺部感染者较多,脑钠肽及肌酐水平较高（均P〈0.05）;三支病变者较多,右冠状动脉及旋支严重病变比例较高（均P〈0.05）;住院期间心力衰竭（43.3%vs29%）、心源性休克（9.6%vs3.1%）及全因死亡（11.8%vs6.1%）发生率显著增高（均P〈0.05）.多因素logistic回归分析显示糖尿病是STEMI患者住院期间出现全因死亡（OR=2.303,95%CI：1.304-4.068）、心源性休克（OR=2.784,95%CI：1.409-5.502）、心力衰竭（OR=2.616,95%CI：1.564-4.375）的独立危险因素.结论 糖尿病患者STEMI住院期间并发症较多、死亡率较高.Objective To evaluate clinical features and in- hospital outcomes of patients with acute ST- segment elevation myocardial infarction （STEMI） and diabetes.Methods Clinical data of 952 inpatients with acute STEMI were retrospectively analyzed.They were divided into diabetic group and non- diabetic group based on whether or not there is diabetes.The clinical features and in- hospital outcomes were compared between the two groups.Results Of 952 STEMI patients,187 cases had diabetes.Diabetic group had more female,non- smoker,and patients with chronic renal insufficiency and pulmonary infection.Serum creatinine and brain natriuretic peptide level,the ratio of three- vessel disease as well as serious lesion of right and left circumflex coronary artery were significantly higher in diabetic group than non- diabetic group.Heart failure,cardiogenic shock and all- cause mortality in hospital were significantly higher in diabetic （43.3%,9.6%,11.8%） than non- diabetic （29%,3.1%,6.1%） （all P〈0.05） group.Multivariate logistic regression analysis showed that diabetes was an independent predictor for all- cause hospital mortality （OR=2.303,95%Cl： 1.304-4.068）,cardiogenic shock （OR=2.784,95%Cl：1.409-5.502） and heart failure （OR=2.616,95%Cl： 1.564-4.375）.Conclusion Diabetic patients have more complications and higher mortality in hospital after STEMI.

关 键 词：糖尿病 ST段抬高型心肌梗死 心源性休克 心力衰竭 

分 类 号：R542.22[医药卫生—心血管疾病]