应激性高血糖对接受经皮冠状动脉介入治疗的急性心肌梗死患者临床预后的影响  

Impact of Stress Hyperglycemia on the Clinical Prognosis of Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

作　　者：齐丽梅[1] 谢莲娜[1] 党凤强 王丽君[1] 陈玉梅 魏显敬[1] 解泽宙[1] QI Li-mei;XIE Lian-na;DANG Feng-qiang;WANG Li-jun;CHEN Yu-mei;WEI Xian-jing;XIE Ze-zhou(Department of Cardiology,Zhongshan Hospital Affiliated to Dalian University.Dalian（116001）,Liaoning,China)

机构地区：[1]大连大学附属中山医院心内科,辽宁省大连市116001

出　　处：《中国循环杂志》2018年第8期756-760,共5页Chinese Circulation Journal

摘　　要：目的:探讨应激性高血糖(SHG)对接受经皮冠状动脉(冠脉)介入治疗(PCI)的急性心肌梗死(AMI)患者近、远期临床预后的影响。方法:对2010-02至2016-03首次患AMI于我院心内科接受PCI的患者655例进行回顾性分析。比较SHG组(空腹血糖≥7.0 mmol/L,67例)、无SHG组(空腹血糖<7.0 mmol/L,320例)和糖尿病组(既往或此次入院后明确诊断,268例)患者住院期间及发病1年主要不良心血管事件(MACE)。结果:三组患者GRACE评分比较,SHG组>糖尿病组>无SHG组,三组比较差异均有统计学意义(P均<0.05)。三组患者Gensini积分比较,糖尿病组>SHG组>无SHG组,糖尿病组与无SHG组比较差异有统计学意义(P<0.05),其余差异无统计学意义(P>0.05)。SHG组患者住院期间全因死亡、心力衰竭及恶性心律失常比例高于无SHG组(P<0.05)。多因素Cox回归模型分析显示SHG、GRACE评分及Gensini积分是患者住院期间全因死亡的独立危险因素,其中SHG是最强的危险因素(OR=4.455,95%CI:1.805~10.997,P=0.001)。SHG组发病1年全因死亡及心力衰竭患者比例高于无SHG组(P<0.05)。Cox回归分析显示年龄、空腹血糖、入院Killip心功能分级Ⅱ~Ⅳ级及Gensini评分是患者发病1年全因死亡的独立危险因素,其中入院Killip心功能分级Ⅱ~Ⅳ级是最强的危险因素(OR=6.901,95%CI:2.812~16.940,P<0.001),其他依次是空腹血糖、年龄和Gensini积分。结论:SHG会影响接受PCI的AMI患者近期及远期预后,和其他危险因素相比,SHG是接受PCI的AMI患者住院期间全因死亡的一项较强的独立危险因素。Objectives： To explore the impact of stress hyperglycemia（SHG） on the clinical prognosis of patients with acute myocardial infarction（AMI） undergoing percutaneous coronary intervention（PCI）.Methods： This retrospective analysis included 655 patients with first AMI, who underwent PCI from 2010-02 to 2016-03 in our hospital. Patients were divided into SHG group（n=67, fasting blood-glucose≥7.0 mmol/L）, non-stress hyperglycemia（non-SHG） group（n=320, fasting blood-glucose 7.0 mmol/L）, and diabetes mellitus group（n=268, patients with diabetes mellitus history or diagnosed with diabetes mellitus after the admission）. Major adverse cardiovascular events（MACE） during hospitalization and at one-year follow-up were compared among patients in various groups. Results： The GRACE score ranked as follows： SHG group diabetes mellitus groupnon-SHG group（P〈0.05）. The Gensini scores ranked as follows： diabetes mellitus group SHG group non-SHG group, which was significantly higher in diabetes mellitus group than in non-SHG group（P〈0.05） and was similar between diabetes mellitus and SHG groups and between SHG group and non-SHG group（P〈0.05）. The all-cause mortality, percent of heart failure and malignant arrhythmia were significantly higher in SHG group than in the non-SHG group（all P〈0.05）. The results of multivariate Cox regression analysis showed that SHG, GRACE score and Gensini score were independent risk factors of the all-cause mortality during hospitalization in this patient cohort（P〈0.05）, and SHG was the strongest risk factor of all-cause mortality during hospitalization（OR=4.455,95%CI：1.805-10.997, P =0.001）. One-year all-cause mortality and prevalence of heart failure were significantly higher in SHG group than that in non-SHG group（all P〈0.05）. The results of multivariate Cox regression analysis showed that age, fasting blood glucose, Killip II-IV grade and Gensini score were independent risk factors for the one-year all-cause mortality�

关 键 词：心肌梗死 经皮冠状动脉介入治疗 应激性高血糖 预后 影响 

分 类 号：R541[医药卫生—心血管疾病]