急慢性血糖比值与急性心肌梗死患者短期不良预后的关系研究  

Relationship between Acute-to-chronic Glycemic Ratio and Poor Short-term Prognosis in Patients with Acute Myocardial Infarction

作　　者：杜发旺[1] 李玲[1] 吴强[1] 陈丹丹[1] 吴玥婷[1] 王纪人[1] 陈保林[1] DU Fawang;LI Ling;WU Qiang;CHEN Dandan;WU Yueting;WANG Jiren;CHEN Baolin(Cardiovascular Department,Guizhou Provincial People's Hospital,Guiyang 550002,China)

机构地区：[1]贵州省人民医院心内科,贵州省贵阳市550002

出　　处：《中国全科医学》2020年第15期1873-1878,共6页Chinese General Practice

基　　金：贵州省科技厅基金项目(黔科合基础〔2017〕1103);贵州省卫计委科学技术基金项目(gzwjkj2018-1-005);国家临床重点专科建设项目(国卫办医函〔2013〕554号);贵州省科学技术厅临床研究中心项目(黔科合平台人才〔2017〕5405)。

摘　　要：背景急性心肌梗死(AMI)患者入院时常存在急性血糖升高,在临床实践中发现,有多种复杂的临床因素可能引起急性血糖升高。急慢性血糖比值可能成为评估患者短期不良预后的预测因子,但目前国内尚缺乏相关研究。目的探讨急慢性血糖比值与AMI患者不良心血管事件及短期不良预后的关系。方法纳入2017年1月-2018年1月在贵州省人民医院CCU住院的AMI患者,包括ST段抬高型心肌梗死(STEMI)和非ST段抬高性心肌梗死(NSTEMI)患者共272例,进行30 d随访,终点事件是死亡。依据终点事件分为存活组和死亡组。患者住院即刻测量急性血糖(静脉血糖)和糖化血红蛋白(HbA1c)水平,依据HbA1c计算慢性血糖,并计算急慢性血糖比值。分析AMI患者短期不良预后的影响因素。绘制急慢性血糖比值预测AMI患者短期不良预后的ROC曲线,计算急慢性血糖比值的最佳截断值;应用Kaplan-Meier法绘制生存曲线,比较不同急慢性血糖比值分组患者不良心血管事件的发生情况。结果存活组256例、死亡组16例。多因素Logistic回归分析显示,Killips分级Ⅱ~Ⅲ级、冠状动脉三支病变及急慢性血糖比值为AMI患者短期不良预后的独立危险因素(OR=23.110、0.073、35.885,P<0.05)。依据最佳截断值将患者分为急慢性血糖比值≤1.01组(n=138)和急慢性血糖比值>1.01组(n=134)。生存分析显示,急慢性血糖比值>1.01组的短期累积生存率(90.3%)低于急慢性血糖比值≤1.01组短期累积生存率(97.8%)(χ^2=6.932,P=0.008)。进一步行非糖尿病及合并糖尿病患者的亚组分析显示,非糖尿病患者中,急慢性血糖比值>1.01亚组患者短期累积生存率(92.3%)低于急慢性血糖比值≤1.01亚组(97.5%)(χ^2=4.465,P=0.035);合并糖尿病的患者中,急慢性血糖比值>1.01亚组累积生存率(86.0%)低于急慢性血糖比值≤1.01亚组(100.0%)(χ^2=5.658,P=0.017)。急慢性血糖比值>1.01组急性肺水肿、心源性休克Background Elevated levels of acute glycemia at hospital admission are common among patients with acute myocardial infarction(AMI).It has been found that in clinical practice,AMI patients are often combined with a variety of complex clinical factors,which may cause acute hyperglycemia.Acute-to-chronic glycemic ratio may be a predictor of poor shortterm prognosis in such patients,but relevant studies are still lacking in China.Objective To study the relationship between acute-to-chronic glycemic ratio and poor short-term prognosis in patients with AMI.Methods We enrolled 272 inpatients with ST-elevation and non-ST-elevation AMI from CCU,Guizhou Provincial People's Hospital between January 2017 and January 2018.The primary end point of the study was mortality within a 30-day follow-up.Venous plasma glycemia and glycosylated hemoglobin(HbA1c)levels were measured at hospital admission,then the chronic glycemia was estimated based on HbA1c,and acute-to-chronic glycemic ratio was calculated further.Factors associated with poor short-term prognosis were analyzed.The ROC curve of acute-to-chronic glycemic ratio in predicting poor short-term prognosis of AMI was plotted,and the optimal cutoff value was estimated.Kaplan-Meier method was used for survival analysis.The incidence of adverse cardiovascular events was explored by acute-to-chronic glycemic ratio.Results By the survival status,the patients were divided into the survival group(n=256)and the death group(n=16).Multivariate Logistic regression analysis showed that Killip classⅡ-Ⅲ,three-vessel coronary artery lesions and elevated acute-to-chronic glycemic ratio were independent risk factors associated with poor short-term prognosis(OR=23.110,0.073,35.885,P<0.05).Patients were divided into acute-to-chronic glycemic ratio>1.01 group(n=138)and≤1.01 group(n=134)by the cutoff value,and the former group had much lower short-term cumulative survival rate(90.3%vs 97.8%)(χ^2=6.932,P=0.008)showed by survival analysis.Further subgroup analysis by diabetes indicated that,t

关 键 词：血糖 血红蛋白A 糖基化 急慢性血糖比值 心肌梗死 短期不良预后 预后 

分 类 号：R446.112[医药卫生—诊断学] R542.22[医药卫生—临床医学]