空腹血糖、白细胞计数和肾小球滤过率评估ST段抬高型心肌梗死患者住院预后的价值  

The Values of Fasting Plasma Glucose,White Blood Cell Count and Glomerular Filtration in Evaluation of In-hospital Outcomes of Patients with ST-segment Elevation Myocardial Infarction

作　　者：黄琨[1] 王婕妤[2] 何咏聪 杜作义[1] HUANG Kun;WANG Jieyu;HE Yongcong;DU Zuoyi(Guangdong Provincial Second General Hospital,Guangzhou 510000,China)

机构地区：[1]广东省第二人民医院,广东广州510220 [2]中山大学孙逸仙纪念医院,广东广州510030

出　　处：《现代医院》2018年第11期1623-1627,共5页Modern Hospitals

摘　　要：目的探讨联合空腹血糖、白细胞计数及肾小球滤过率(e GFR)评估急性ST段抬高型心肌梗死(STEMI)患者住院预后的价值。方法依据住院期间心血管事件发生情况将380例STEMI患者分为发生组(154例)和未发生组(226例),比较两组患者的临床特征;根据患者空腹血糖≥5. 6 mmol/L,白细胞计数≥14. 30×10~9/L及eGFR <60 mL·min-1·(1. 73m^2)^(-1)3个因素存在的数量分为0、1、2、3四组,分别称为Ⅰ组、Ⅱ组、Ⅲ组和Ⅳ组,比较各组患者的临床特征及心血管事件发生率;采用多元Logistic回归分析对影响STEMI患者住院期间心血管事件的相关因素进行分析。结果心血管事件发生组空腹血糖、白细胞计数均高于未发生组及e GFR低于未发生组;四组心血管事件发生率分别为22. 4%、27. 5%、49. 0%和75. 0%(P <0. 001);同时存在3个危险因素的患者心血管事件发生风险是没有任何危险因素的7. 22倍。结论空腹血糖、白细胞计数及e GFR对STEMI患者住院期间发生心血管事件具有较好的预警作用。随着危险因素数量的增加,心血管事件发生率呈递增趋势。Objective To evaluate the value of fasting plasma glucose, white blood cell count and glomerular filtration rate in evaluation of in-hospital outcomes of patients with ST-segment elevation myocardial infarction. Methods A total of 380 patients with STEMI were divided into groups with and without cardiac events （ n =154, n =226, respectively） which occurred during hospitalization. The two groups were compared in terms of the clinical characteristics. The patients were divided into four sub-groups I, II, III and IV （ n =0, 1, 2 and 3, respectively） according to the number of the following 3 variables： plasma glucose ≥ 5.6 mmol/L, white blood cell counts ≥ 14.30×10^9/L, and eGFR 〈 60 mL/min. We compared clinical characteristics and the incidence of cardiac events during hospitalization among these groups. Multiple Logistic regression analysis was applied to examine predictors of relevant factors affecting in-hospital cardiac events in STEMI patients. Results The level of fasting plasma glucose and white blood cell counts in the cardiac events group were significantly higher than that in the non-cardiac events group, and it was on the contrary concerning eGFR. The incidence of cardiac events of the four groups was 22.4%, 27.5%, 49.0%, and 75.0%, respectively （ P 〈0.001）. The patients with all 3 variables had a 7.22-hold higher risk of the incidence of cardiac events compared with the patients without these variables.Conclusion Fasting plasma glucose, white blood cell counts and eGFR may better provide early warning for occurrence of cardiac events in the patients with STEMI. The incidence of cardiac events could progressively increase as the number of these 3 variables increases.

关 键 词：心肌梗死 空腹血糖 白细胞计数 肾小球滤过率 预后 

分 类 号：R446[医药卫生—诊断学] R542.22[医药卫生—临床医学]