应激性高血糖及氧化应激产物水平对急性心肌梗死患者预后的评估价值  

Evaluation on prognosis of patients with acute myocardial infarction by stress hyperglycemia and levels of oxidative stress products

作　　者：汤莉莹[1] 白玉芝[1] 王晶[1] 茹静[1] 赵霞[1] 安芸[1] Tang Li-ying;Bai Yu-zhi;Wang Jing;Ru Jing;Zhao Xia;An Yun(Department of Geriatrics,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院老年科,北京100043

出　　处：《中国急救医学》2019年第1期57-60,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨应激性高血糖及氧化应激产物水平对急性心肌梗死(AMI)患者预后的评估价值。方法选取2015年1月至2017年8月首都医科大学附属北京朝阳医院AMI患者160例,设为A组。再根据血糖值分为A1组(应激性高血糖组,FBG≥7.0 mmol/L)、A2组(无应激性高血糖组,FBG<7.0 mmol/L)。另选取健康志愿者50例,设为B组。检测各组患者血糖及氧化应激指标水平,包括谷胱甘肽过氧化物酶(GSH-Px)、过氧化氢酶(CAT)、超氧化物歧化酶(SOD)、丙二醛(MDA)。随访记录A组患者感染、心血管事件、死亡等不良预后事件的发生率。结果160例AMI患者中,应激性高血糖发生率35.0%。A1组、A2组血清GSH-Px、CAT、SOD水平均低于B组相应水平,MDA水平均高于B组水平(t=5.17~9.05,P<0.05或P<0.01)。且A1组血清GSH-Px水平[(451.72±82.60)U/L vs.(624.53±96.05)U/L]、CAT[(10.92±2.07)U/L vs.(14.35±2.81)U/L]、SOD[(50.32±8.12)μU/L vs.(63.07±7.53)μU/L]均低于A2组,MDA水平[(8.17±1.01)μmol/L vs.(5.72±0.80)μmol/L]高于A2组(t=4.17~5.03,P<0.05)。A组受试者血清FBG与GSH-Px、CAT、SOD水平均呈负相关(rGSH-Px=-0.46、rCAT=-0.89、rSOD=-0.62,P<0.05),与MDA水平呈正相关(rMDA=0.47,P<0.05)。A1组感染(21.43%vs.9.62%)与病死率(23.21%vs.8.65%)及严重心律失常(30.36%vs.14.42%)、心源性休克(25.00%vs.12.50%)、心力衰竭(30.36%vs.15.38%)和其他心血管事件(25.00%vs.12.50%)发生率均高于A2组(χ2=4.05~6.51,P<0.05)。结论应激性高血糖与氧化应激可能均参与了AMI的发生与发展,两者联合检测可作为判断AMI患者短期预后的指标,应激性高血糖及高氧化应激状态多预示AMI患者预后欠佳。Objective To investigate the evaluation value on prognosis of patients with acute myocardial infarction(AMI)by stress hyperglycemia and levels of oxidative stress products.Methods 160 patients with AMI were selected as group A,and were divided into group Al(stress hyperglycemia group,FBG≥7.0 mmol/L)and group A2(non-stress hyperglycemia group,FBG﹤7.0 mmol/L)by the blood glucose results.Another 50 volunteers were selected as group B.The levels of blood glucose and oxidative stress indicators were measured in two groups’including glutathione peroxidase(GSH-Px),catalase(CAT),superoxide dismutase(SOD),and malondialdehyde(MDA).Rates of infection,adverse prognostic events such as cardiovascular events and death were compared in group A by follow-up.Results In 160 patients with AMI,the incidence of stress hyperglycemia was 35.0%.The serum levels of GSH-Px,CAT and SOD in the group Al and A2 were lower than those in group B,and the MDA levels were higher than those in group B(t=5.17~9.05,P﹤0.05 or P﹤0.01).The serum levels of GSH-Px[(451.72+82.60)U/L vs.(624.53±96.05)U/L],CAT[(10.92±2.07)U/L vs.(14.35±2.81)U/L]and SOD[(50.32±8.12)p,U/L vs.(63.07±7.53)μU/L]in group Al were lower than those in group A2,and the levels of MDA[(8.17±1.01)μmoI/L vs.(5.72±0.80)μmol/L]were higher than that in group A2(t=4.17-5.03,P﹤0.05).Serum FBG was negatively correlated with GSH-Px,CAT,and SOD levels in group A(rQSH_px=-0.46,rCAT=-0.89,rS0D=-Q.62,P﹤0.05),and positively correlated with MDA levels in group A(rMDA=0.47,P﹤0.05).The incidence of infection(21.43%vs.9.62%)and death(23.21%vs.8.65%),severe arrhythmia(30.36%vs.14.42%),cardiogenic shock(25.00%vs.12.50%),heart failure(30.36%vs.15.38%)and other cardiovascular events(25.00%vs.12.50%)in group Al were higher than those in group A2(x^2=4.05~6.51,P﹤0.05).Conclusion Stress hyperglycemia and oxidative stress may participate in the occurrence and development of AML The combined detection of both may serve as an index to predict the recent prognosis of AMI patients.Stress

关 键 词：急性心肌梗死 应激性高血糖 氧化应激 预后 

分 类 号：R542.22[医药卫生—心血管疾病]