入院应激性高血糖联合糖化血红蛋白对非糖尿病急性心肌梗死患者PCI治疗后中长期临床预后的影响  

Impact of admission hyperglycemia and glycosylated hemoglobin A_(1c) on clinical prognosis of non-diabetic patients with acute myocardial infarction after percutaneous coronary intervention

作　　者：彭凌云[1] 刘安康 丁怀胜[1] 王惠[1] 李原[1] PENG Ling-yun;LIU An-kang;DING Huai-sheng;WANG Hui;LI Yuan(Department of Cardiology,Meishan City People′s Hospital,Meishan,Sichuan 620010,China)

机构地区：[1]四川省眉山市人民医院心内科,四川眉山620010

出　　处：《岭南心血管病杂志》2017年第6期689-692,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨入院应激性高血糖联合糖化血红蛋白(glycosylated hemoglobin A_(1c),HbA_(1c))对非糖尿病急性心肌梗死患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后中长期临床预后的影响。方法入选452例行PCI治疗的非糖尿病急性心肌梗死患者,根据入院血糖(admission glucose,AG)及HbA_(1c)浓度被分为4组:A组(AG<120 mg/dL+HbA_(1c)<5.1%,n=113);B组(AG<120 mg/dL+HbA_(1c)≥5.1%,n=114);C组(AG≥120 mg/dL+HbA_(1c)<5.1%,n=108);D组(AG≥120 mg/dL+HbA_(1c)≥5.1%,n=117)。主要终点包括全因死亡及非致死性心肌梗死,并对比各组患者基线、临床特征及其他主要心血管事件(major adverse cardiovascularevents,MACE)的发生情况。结果所有患者的主要终点事件发生率为13.7%。与其他3组相比,D组患者的全因病死率(15.7%)、非致死性心肌梗死(6.8%)及其他MACE事件发生率(8.6%)均明显增高,差异有统计学意义(均P<0.05)。多因素分析入院高血糖合并高HbA_(1c)浓度可作为主要终点事件发生的独立预测因子(HR=2.65;95%CI:1.17~6.58,P=0.02)。结论入院高血糖合并高HbA_(1c)浓度可明显增加非糖尿病急性心肌梗死患者PCI治术后全因死亡、非致死性心肌梗死及其他MACE事件的发生率,并作为临床预后的独立预测因子。Objectives To investigate how do admission hyperglycemia and glycosylated hemoglobin A1c(HbA1c)affect clinical prognosis of non-diabetic patients with acute myocardial infarction(AMI)after primary percutaneouscoronary intervention(p-PCI).Methods We retrospectively analyzed452consecutive non-diabetic patients withAMI.All patients were treated with p-PCI.Patients were divided into4groups according to the median values of admis?sion glucose(AG)and HbA1c.Group A:AG<120mg/dL+HbA1c<5.1%(n=113);Group B:AG<120mg/dL+HbA1c≥5.1%(n=114);Group C:AG≥120mg/dL+HbA1c<5.1%(n=108);Group D:AG≥120mg/dL+HbA1c≥5.1%(n=117).The primary endpoint included a composite of all-cause death and non-fatal myocardial infarction.The4groups werecompared with respect to baseline characteristics,clinical characteristics and other major adverse cardiovascular events(MACE).Results The primary endpoint occurred in13.7%of the participants.Compared with other groups,incidence of non-fatal myocardial infarction(6.8%),MACE(8.6%)and all-cause mortality(15.7%)were significantlyhigher in D group(P<0.05).On multivariate analysis,combination of elevated AG and HbA1c concentrations was anindependent predictor of the primary endpoint(HR=2.65;95%CI:1.17-6.58,P=0.02).Conclusions In patients withAMI undergoing p-PCI,who with combination of elevated AG and HbA1c concentrations experienced a significantlyhigher incidence of non-fatal myocardial infarction,MACE and all-cause mortality.Combination of elevated AG andHbA1c concentrations can act as an independent predictor of long-term clinical outcomes.

关 键 词：心肌梗死 入院高血糖 糖化血红蛋白 临床预后 

分 类 号：R542.22[医药卫生—心血管疾病]