吸烟与急性心肌梗死应激性高血糖的相关风险性分析  

Association of cigarette smoke and stress-induced hyperglycemia in patients with acute ST-elevation myocardial infarction

作　　者：曹丽华 刘泽森 李云涛 陈妍[4] 孟康[2] CAO Lihua LIU Zesen LI Yuntao CHEN Yan MENG Kang(Department of General Practice, Beixiaguan Street Community Health Center, Haidian District, Beijing 100081, China)

机构地区：[1]北京海淀区北下关社区卫生服务中心全科内科,100081 [2]北京安贞医院心内科 [3]北京民航医院心内科 [4]天津市胸科医院心内科

出　　处：《心肺血管病杂志》2017年第8期653-657,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市卫生系统高层次卫生技术人才培养计划(2014-3-039)

摘　　要：目的:探讨吸烟是否增加急性心肌梗死(AMI)患者应激性高血糖的风险。方法:入选2014年2月至2016年2月,因AMI在北京安贞医院就诊治疗的非糖尿病患者。所有入选患者入院后查血常规,心肌酶、肝肾功能、糖化血红蛋白等检查。监测空腹血糖,并完成急诊冠状动脉造影检查及经皮冠状动脉介入治疗。根据是否吸烟分为吸烟组和非吸烟组,按照年龄(±5岁)、性别、合并疾病等资料进行1∶1匹配。分别调查应激性高血糖的发生率,并进行心肌梗死相关资料比较。结果:研究收集646例患者,按照入选标准及样本含量计算要求,吸烟组入选223例,按照性别、年龄、AMI病史等条件要求匹配非吸烟组患者223例。吸烟组患者的空腹血糖、糖化血红蛋白水平等高于非吸烟高血糖组[(7.5±2.9)vs.(6.8±2.5)mmol/L,P<0.05];[(5.6±0.4)%vs.(5.4±0.4)%,P<0.05]。AMI后应激性高血糖的发生率为27.1%,吸烟组患者明显高于非吸烟组(35.0%vs.19.3%,χ~2=13.9,P=0.000)。多因素Logistic回归分析显示,吸烟是AMI后应激性高血糖发生的独立危险因素。结论:吸烟增加非糖尿病AMI患者应激性高血糖发生的风险。Objective： We investigate the association of stress-induced hyperglycemia following tobacco smoking in patients with acute myocardial infarction. Methods： After admission,routine blood,liver and kidney function tests et al were conducted,and fasting plasma glucose levels,serum cardiac enzyme concentrations,and serum lipid levels were measured. ECGs,ultrasonic cardiograph,and chest X-rays were conducted.Patients who suffered acute myocardial infarction patients were divided into smoking and non-smoking based on the presence or absence of cigarette. The incidence of stress-induced hyperglycemia was monitored. We investigated the associations of tobacco smoking and stress-induced hyperglycemia. Results： Overall 646 patients with AMI who met the inclusion criteria were enrolled in this observational analysis. All selected AMI patients were divided into the smoking group and non-smoking group. 223 patients were in the smoking group,the control group was selected from patients with non-smoking and individually matched（ 1∶ 1） to each smoking patient based on age（ ± 5 years）,sex,history of AMI,et al. In patients with smoking group,glucose,HbA1c（ Glycated haemoglobin） was higher than non-smoking patients [（ 7. 5 ± 2. 9） vs.（ 6. 8 ± 2. 5） mmol/L,P〈0. 05 ];[（ 5. 6 ± 0. 4） % vs.（ 5. 4 ± 0. 4） %,P〈0. 05]. The frequency of in-hospital stress hyperglycemia was27. 1%. The occurrence of stress-induced hyperglycemia in cigarette smoke group was higher than that in nonsmoking group [34. 5%（ 78/223） vs. 19. 3%（ 43/223）,P = 0. 000]. Smoking is an independent risk factor of stress-induced hyperglycemia. Conclusion： Cigarette smoke is associated with an increased risk of stress hyperglycemia in patients without diabetes after acute myocardial infarction.

关 键 词：吸烟 急性心肌梗死 应激性高血糖 

分 类 号：R54[医药卫生—心血管疾病]