糖化血红蛋白水平对急性ST段抬高型心肌梗死患者介入治疗远期预后的影响  

Impact of Glycated Hemoglobin Level on Long-term Outcomes of Patients With ST-segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

作　　者：郭玉凡[1] 王泽荣[1] 路超[1] 焦利东 杜国良[1] 王平 俞梦越[2] 贾海莲[1] GUO Yufan;WANG Zerong;LU Chao;JIAO Lidong;DU Guoliang;WANG Ping;YU Mengyue;JIA Hailian(The First Department of Cardiology,Anyang Traditional Chinese Medicine Hospital,Anyang,455000,Henan,China)

机构地区：[1]安阳市中医院心病一科,河南省455000 [2]中国医学科学院,北京协和医学院,国家心血管病中心阜外医院

出　　处：《中国循环杂志》2021年第8期762-768,共7页Chinese Circulation Journal

基　　金：国家自然科学基金(81670415)。

摘　　要：目的:探索糖化血红蛋白(HbA_(1c))对急性ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入治疗(PCI)后远期预后的影响。方法:连续性纳入2010年1月至2015年12月在安阳市中医院心内科行PCI的STEMI患者1228例。按照糖代谢水平,将入选患者分为正常糖代谢组(HbA_(1c)≤5.6%,n=415)、糖尿病前期组(HbA_(1c)5.7%~6.4%,n=285)及糖尿病组(已知或新诊断,n=528)。比较三组患者的基线特征及远期预后。同时分析基线HbA_(1c)水平与预后的相关性。主要研究终点为PCI后5年内主要不良心血管事件(MACE,全因死亡、非致死性心肌梗死和非计划血运重建的复合终点)。结果:基线HbA_(1c)水平越高,患者冠状动脉病变越显著。糖尿病组MACE的发生率(16.8%)显著高于正常糖代谢组(6.7%)及糖尿病前期组(9.8%),差异具有统计学意义(P均<0.05)。以正常糖代谢组为参照,多因素Cox回归分析显示糖尿病前期组MACE的发生风险有所增加,但差异无统计学意义(HR=1.34,95%CI:0.69~2.58,P=0.382),而糖尿病组风险显著增加(HR=2.24,95%CI:1.31~3.85,P=0.003)。在所有患者中,MACE事件风险随HbA_(1c)的升高有上升趋势,多因素校正后,HbA_(1c)升高是STEMI患者PCI后远期预后不良的独立危险因素(HR=1.16,95%CI:1.03~1.34,P=0.005)。结论:糖尿病是STEMI患者PCI后发生MACE的独立危险因素,而以HbA_(1c)界定的糖尿病前期并非该人群的独立预测因子。基线HbA_(1c)水平对于评估该人群的远期预后具有重要意义。Objectives:To investigate the association of glucometabolic state as well as baseline glycated hemoglobin(HbA_(1c))level with future risk of adverse events in patients with ST-segment elevation myocardial infarction(STEMI)undergoing percutaneous coronary intervention(PCI).Methods:A total of 1228 consecutive STEMI patients treated with PCI in Anyang Traditional Chinese Medical Hospital from January 2010 to December 2015.Patients were included and divided into three groups according to their glucometabolic state:415 patients with normoglycemia(HbA_(1c)≤5.6%),285 with prediabetes(pre-DM,HbA_(1c)5.7%-6.4%),and 528 with diabetes(known or newly diagnosed DM).Baseline data and clinical outcomes among the 3 groups were compared.Association between baseline HbA_(1c)level and outcomes were also analyzed.The study endpoint was 5-year major adverse cardiovascular events(MACE,a composite of all-cause death,nonfatal myocardial infarction and unplanned revascularization).Results:The severity of coronary artery stenosis were more significant in patients with higher admission HbA_(1c)level.As for long-term outcomes,DM patients(16.8%)had significantly higher rates of MACE than normoglycemic(6.7%)and prediabetic patients(9.8%).Multivariate cox regression analysis showed that DM was associated with a higher risk of MACE as compared with normoglycemia(HR=2.24,95%CI:1.31-3.85,P=0.003).Meanwhile,MACE rate tended to be higher in pre-DM patients as compared with normoglycemic patients(HR=1.34,95%CI:0.69-2.58,P=0.382).In entire STEMI patients after PCI,the MACE risk showed an upward trend in proportion with increasing HbA_(1c)level.After multivariate adjustments,elevated HbA_(1c)was independently associated with an increased risk of MACE(HR=1.16,95%CI:1.03-1.34,P=0.005).Conclusions:DM,but not pre-DM,is an independent risk factor for increased risk of MACE in STEMI patients undergoing PCI.Assessment of baseline HbA_(1c)is of critical value to identify subjects with higher risk of worse outcome in STEMI patients requiring PCI.

关 键 词：糖代谢水平 糖化血红蛋白 ST段抬高型心肌梗死 经皮冠状动脉介入治疗 心血管预后 

分 类 号：R54[医药卫生—心血管疾病]