胰岛素强化治疗对急性心肌梗死伴应激性高血糖患者经皮冠状动脉介入治疗后炎性反应、心功能及主要不良心血管事件的影响  

Effect of Intensive Insulin Therapy on Inflammatory Reaction,Cardiac Function and Major Adverse Cardiovascular Events in Patients with Acute Myocardial Infarction and Stress Hyperglycemia after Percutaneous Coronary Intervention

作　　者：孟爱亮 武莉芳[1] 孙伯玉 王辉[1] 王佳敏 MENG Ailiang;WU Lifang;SUN Boyu;WANG Hui;WANG Jiamin(Department of Emergency,the Second Affiliated Hospital of Hebei North University,Zhangjiakou 075100,China)

机构地区：[1]河北北方学院附属第二医院急诊科,河北省张家口市075100

出　　处：《实用心脑肺血管病杂志》2021年第1期75-79,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：张家口市重点研发计划项目(1921022D)。

摘　　要：背景研究表明,胰岛素强化治疗可有效控制急性心肌梗死(AMI)伴应激性高血糖(SHG)患者血糖,但对AMI的影响尚未明确。目的探讨胰岛素强化治疗对AMI伴SHG患者经皮冠状动脉介入治疗(PCI)后炎性反应、心功能及主要不良心血管事件(MACE)的影响。方法选取2017年1月—2019年6月河北北方学院附属第二医院心内科收治的AMI伴SHG患者106例,采用随机数字表法分为对照组与观察组,每组53例。两组患者均予以PCI及常规药物治疗,术后对照组患者在糖尿病饮食及常规治疗基础上临时给予胰岛素治疗,术后观察组患者在糖尿病饮食基础上予以胰岛素强化治疗。比较两组患者术前及术后7 d心肌标志物〔肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、N末端脑钠肽前体(NT-proBNP)〕、炎性指标〔白介素16(IL-16)、白介素18(IL-18)及基质金属蛋白酶9(MMP-9)〕、心功能指标〔左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)及左心室射血分数(LVEF)〕及治疗期间MACE发生情况。结果术后7 d,观察组患者血清CK-MB、cTnI、NT-proBNP水平低于对照组(P<0.05)。两组患者术后7 d血清CK-MB、cTnI、NT-proBNP水平分别低于本组术前(P<0.05)。术后7 d观察组患者血清IL-16、IL-18、MMP-9水平低于对照组(P<0.05)。两组患者术后7 d血清IL-16、IL-18、MMP-9水平分别低于本组术前(P<0.05)。术后7 d观察组患者LVEDD、LVESD小于对照组,LVEF高于对照组(P<0.05)。两组患者术后7 d LVEDD、LVESD分别小于本组术前,LVEF分别高于本组术前(P<0.05)。观察组患者治疗期间MACE发生率为5.7%(3/53),低于对照组的20.8%(11/53)(P<0.05)。结论胰岛素强化治疗可有效减轻AMI伴SHG患者PCI后心肌损伤及炎性反应,改善患者心功能,降低MACE发生率,安全性较高。Background Studies have shown that,intensive insulin therapy can effectively control blood glucose in patients with acute myocardial infarction(AMI)and stress hyperglycemia(SHG),but the effect of intensive insulin therapy on AMI is not clear.Objective To investigate the effect of intensive insulin therapy on inflammatory reaction,cardiac function and major adverse cardiovascular events(MACE)in patients with AMI and SHG after percutaneous coronary intervention(PCI).Methods A total of 106 patients with AMI and SHG in Department of Cardiology,the Second Affiliated Hospital of Hebei North University from January 2017 to June 2019 were selected,and they were divided into control group(n=53)and observation group(n=53)by random number table method.Patients in both groups were treated with PCI and conventional medications,patients in the control group were temporarily given insulin therapy on the basis of diabetes diet and routine treatment,while patients in the observation group were given intensive insulin therapy on the basis of diabetes diet.The myocardial markers〔creatine kinase isoenzyme(CK-MB),cardiac troponin I(cTnI),N-terminal pro brain natriuretic peptide(NT-proBNP)〕,inflammatory indexes〔interleukin-16(IL-16),interleukin-18(IL-18)and matrix metalloproteinase-9(MMP-9)〕,cardiac function indexes〔left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD)and left ventricular ejection fraction(LVEF)〕before operation and 7 days after operation and the incidence of MACE during treatment were compared between the two groups.Results 7 days after operation,the serum levels of CK-MB,cTnI and NTproBNP in the observation group were lower than those in the control group(P<0.05).The serum levels of CK-MB,cTnI and NT-proBNP in the two groups 7 days after operation were lower than those before operation,respectively(P<0.05).7 days after operation,the serum levels of IL-16,IL-18 and MMP-9 in the observation group were lower than those in the control group(P<0.05).The serum levels of I

关 键 词：心肌梗死 应激性高血糖 胰岛素 强化治疗 炎性指标 心功能 主要不良心血管事件 

分 类 号：R542.22[医药卫生—心血管疾病]