急性心肌梗死患者急性期高血糖与心血管不良事件的相关性研究  

Relationship between acute hyperglycemia and adverse cardiovascular events in patients with acute myocardial infarction

作　　者：骆晓蓉 于飞 景宏美[3] LUO Xiao-rong;YU Fei;JING Hong-mei(Medical College of Nantong University,Nantong 226000,China;Department of Cardiology,Jingjiang People's Hospital,Jingjiang 214500,China;Department of Cardiology,Affiliated Hospital of Nantong University,Nantong 226001,China)

机构地区：[1]南通大学医学院,江苏省南通市226000 [2]靖江人民医院心内科 [3]南通大学附属医院心内科

出　　处：《中国心血管病研究》2020年第1期86-92,共7页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨不同类型心肌梗死患者急性期高血糖与其心血管不良事件及病情严重程度的关系。方法收集2017年9月到2019年5月于南通大学附属医院诊断为急性心肌梗死(acute myocardial infarction,AMI)的患者183例,分为ST段抬高型99例(ST-elevation myocardial infarction,STEMI)及非ST段抬高型84例(non-ST elevation myocardial infarction,NSTEMI),根据入院即刻血糖(admission blood glucose,ABG)、入院后首次(次日)空腹血糖(the first fasting blood glucose,FBG)、是否合并有糖尿病为切点,回顾性分析各组患者住院期间急性期高血糖与主要心血管不良事件(心力衰竭、恶性心律失常、死亡)以及心肌梗死后心功能状态的相关指标[Killip分级、左心室射血分数(left ventricular ejection fraction,LVEF)、脑钠肽(brain natriuretic peptide,BNP)]和心肌梗死后心肌缺血、病变严重程度及范围的相关指标(冠状动脉病变支数、冠状动脉病变评分)的关系。结果对NSTEMI患者分析,高糖组中主要心血管不良事件的发生率虽较血糖正常组高,但差异均无统计学意义。对STEMI患者分析,根据ABG分为高糖D1组和正常血糖D2组:D1组中发生心力衰竭的患者占44.4%高于D2组13.3%(P=0.001);D1组中发生恶性心律失常的患者占51.9%高于D2组22.2%(P=0.003);另D1组的病死率较D2组虽高,但其差异无统计学意义;根据FBG分为高糖E1组和正常血糖E2组:E1组中发生心力衰竭的患者占46.2%高于E2组20.0%(P=0.006);E1组中发生恶性心律失常的患者占53.8%高于E2组28.3%(P=0.010);El组中死亡患者30.8%高于E2组8.3%(P=0.004)o根据是否合并有糖尿病,分为糖尿病组Fl和非糖尿病组F2:F1组中死亡患者30.8%明显高于F2组&3%(P=0.004);Fl组心力衰竭、恶性心律失常的发生率较F2组虽高,但其差异均无统计学意义。ABG、FBG水平与Killip分级(急性心肌梗死所致心力衰竭的临床分级)、BNP、冠状动脉病变支数.Gensini积分(冠状动脉病变评分Objective To investigate the relationship between acute hyperglycemia and adverse cardiovascular events and severity of illness in different types of acute myocardial infarction(AMI)patients.Methods The study involved 183 patients who were admitted to the Hospital Affiliated to Nantong University with a diagnosis of acute myocardial infarction(AMI)from September 2017 to May 2019,which were divided into ST-elevation myocardial infarction(STEMI,99 cases)and non-ST elevation myocardial infarction(NSTEMI,84 cases).According to the level of admission blood glucose(ABG),the first fasting blood glucose(FBG)and whether the patients were complicated with diabetes mellitus,the relationship between acute hyperglycemia and major adverse cardiovascular events during hospitalization of patients in each group(heart failure,malignant arrhythmia,death)and related indexes of cardiac function after myocardial infarction(KiHip classification,LVEF,BNP)and related indexes of severity and extent of myocardial ischemia after myocardial infarction(The number of coronary artery lesions,Gensini score)were retrospectively analyzed.Results Analysis of patients in acute NSTEMI:Although the morbidity of malignant arrhythmia,heart failure and mortality were higher in the high blood glucose group than that in the normal blood glucose group,there were no statistical significance between those groups in NSTEMI group.The patients in acute STEMI were divided into DI group(High blood glucose group,ABG>7.8 mmol/L)and D2 group(The normal blood glucose group,ABG<7.8 mmol/L).The ratio of heart failure after AMI in group DI was 44.4%,which was higher than 13.3%in group D2(P=0.001).The ratio of malignant arrhythmia after AMI in group DI was 51.9%,which was higher than 22.2%in group D2(P=0.003).The patients were divided into El group(High blood glucose group,FBG>7.0 mmol/L)and E2 group(The normal blood glucose group,FBG<7.0 mmol/L).The ratio of heart failure after AMI in group El was 46.2%,which was higher than 20.0%in group E2(P=0.006).The ratio of maligna

关 键 词：急性心肌梗死 急性期高血糖 非ST段抬高型心肌梗死 ST段抬高型心肌梗死 冠状动脉病变评分 

分 类 号：R542.22[医药卫生—心血管疾病]