胰岛素强化降糖治疗对AMI伴高血糖患者心室重构及血清炎性因子影响的Meta分析  

Meta-analysis of the Effect of Insulin Intensive Hypoglycemic Therapy on Ventricular Remodeling and Serum Inflammatory Factors in Patients with AMI with Hyperglycemia

作　　者：李亚 宋大庆[2] 韩翔宇[2] 肖立运 王冉 王健[1,2] LI Ya;SONG Da-qing;HAN Xiang-yu;XIAO Li-yun;WANG Ran;WANG Jian(Clinical School,Jining Medical University,Jining 272067,Shandong,China;Department of Emergency Medicine,Jining First People's Hospital,Jining 272011,Shandong,China)

机构地区：[1]济宁医学院临床医学院,山东济宁272067 [2]济宁市第一人民医院急诊内科,山东济宁272011

出　　处：《医学信息》2021年第7期110-115,共6页Journal of Medical Information

摘　　要：目的系统评价胰岛素强化降糖治疗对急心肌梗死(AMI)伴高血糖患者心室重构及血清炎症因子水平的影响。方法检索2020年10月15日前发表的在AMI患者中胰岛素强化降糖治疗的随机对照研究(RCT)的文献,试验组胰岛素强化控制血糖,对照组常规降糖处理;Stata16.0软件行Meta分析,并行发表偏移及敏感性分析。结果共纳入15篇RCT研究,共计2069例AMI伴高血糖患者;Meta分析结果显示胰岛素强化降糖治疗可显著改善AMI伴高血糖患者左室射血分数(LVEF)[WMD=5.60,95%CI(4.16,7.03),P<0.01],有效降低左室收缩末期容积指数(LVESVI)[WMD=-1.34,95%CI(-2.43,-0.25),P=0.016]和左室舒张末期内径(LVEDD)[WMD=-1.19,95%CI(-2.21,-0.17),P=0.022],提高心肌灌注[WMD=2.85,95%CI(1.45,4.21),P<0.01],降低PCI术后无复流发生率[RR=0.53,95%CI(0.34,0.82),P=0.004],降低炎性因子水平HS-CRP[WMD=-4.73,95%CI(-6.85,-2.61),P<0.01],TNF-α[WMD=-3.69,95%CI(-5.31,-2.07),P<0.01],降低院内总MACEs事件[RR=0.61,95%CI(0.52,0.72),P<0.01]及长期心力衰竭发生[RR=0.26,95%CI(0.11,0.65),P=0.004],而对长期生存率无显著影响[RR=0.94,95%CI(0.58,0.52),P=0.795]。强化降糖低血糖风险增加[RR=3.21,95%CI(1.85,5.65),P<0.01]。结论本研究发现胰岛素强化降糖治疗能够抑制炎症反应,改善心室重构的有益作用;但降糖过程中仍需避免发生低血糖。Objective To systematically evaluate the effect of insulin intensive hypoglycemic therapy on ventricular remodeling and serum inflammatory factor levels in patients with acute myocardial infarction(AMI)with hyperglycemia.Methods To search for the literature of randomized controlled trials(RCT)of insulin intensive hypoglycemic therapy in AMI patients published before October 15,2020,in the experimental group,insulin intensive control of blood glucose,and the control group with routine hypoglycemic treatment;Meta analysis was performed on Stata16.0 software,and the deviation and sensitivity analysis were published in parallel.Results A total of 15 RCT studies were included,with a total of 2069 patients with AMI and hyperglycemia;the results of Meta analysis showed that insulin intensive hypoglycemic therapy can significantly improve the left ventricular ejection fraction(LVEF)in patients with AMI and hyperglycemia[WMD=5.60,95%CI(4.16,7.03),P<0.01],effectively reduce the left ventricular end systolic volume index(LVESVI)[WMD=-1.34,95%CI(-2.43,-0.25),P=0.016]and left ventricular end diastolic diameter(LVEDD)[WMD=-1.19,95%CI(-2.21,-0.17),P=0.022]:improve myocardial perfusion[WMD=2.85,95%CI(1.45,4.21),P<0.01],reduce the incidence of no-reflow after PCI[RR=0.53,95%CI(0.34,0.82),P=0.004],reduce the level of inflammatory factors HS-CRP[WMD=-4.73,95%CI(-6.85,-2.61),P<0.01],TNF-α[WMD=-3.69,95%CI(-5.31,-2.07),P<0.01],reduce the total number of MACEs events in the hospital[RR=0.61,95%CI(0.52,0.72),P<0.01]and the occurrence of long-term heart failure[RR=0.26,95%CI(0.11,0.65),P=0.004],there was no significant effect on the long-term survival rate[RR=0.94,95%CI(0.58,0.52),P=0.795].The risk of intensive hypoglycemia and hypoglycemia increases[RR=3.21,95%CI(1.85,5.65),P<0.01].Conclusion This study found that insulin intensive hypoglycemic therapy can inhibit the inflammatory response and improve the beneficial effects of ventricular remodeling;however,it is still necessary to avoid hypoglycemia in the process of hypoglycemia.

关 键 词：胰岛素 急性心肌梗死 心室重构 炎性因子 

分 类 号：R977.15[医药卫生—药品]