血糖对重症急性心肌梗死患者短期预后的影响:基于MIMIC数据库的回顾性分析  

Influence of blood sugar on short-term prognosis in patients with severe acute myocardial infarction: a retrospective analysis based on MIMIC database

作　　者：马瑞聪 刘涛 杲建波 茆诗源 张凤云 张卓琦 王志荣 Ma Ruicong;Liu Tao;Gao Jianbo;Mao Shiyuan;Zhang Fengyun;Zhang Zhuoqi;Wang Zhirong(Department of Cardiovascular Medicine,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China;不详)

机构地区：[1]徐州医科大学附属医院心血管内科,徐州221000

出　　处：《中国循证心血管医学杂志》2022年第12期1487-1491,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的 探讨入室血糖对重症监护室(ICU)急性心肌梗死(AMI)患者短期预后的影响。方法回顾性分析来自重症监护医学信息数据库(MIMIC-Ⅳ)中AMI患者的临床资料,收集患者的各项临床资料以及实验室指标,所有患者均有入室血糖检测结果。主要终点事件为入院28 d死亡率。采用单因素和多因素Logistic回归分析影响急性心肌梗死患者死亡的危险因素。另采用Lowess曲线分析血糖与该人群28 d死亡率的关系,并进行亚组分析血糖在AMI合并或不合并的糖尿病的价值。结果 入室血糖是AMI患者28 d死亡率的独立危险因素(OR=1.09,95%CI:1.03~1.05,P=0.005),Lowess曲线表明血糖与AMI28 d死亡率近似U性关系,拐点为5.39 mmol/L(P<0.001),当血糖<5.39 mmol/L时,随着血糖升高,28 d死亡率逐渐降低(OR=0.50,95%CI:0.31~0.79,P=0.0028),当血糖>5.39 mmol/L时,随着血糖升高,28 d死亡率逐渐增加(OR=1.20,95%CI:1.15~1.25,P<0.0001),亚组分析显示与未合并糖尿病患者相比,血糖对于合并糖尿患者28 d死亡率的影响较小(OR=1.23,95%CI:1.016~1.30 vs. OR=1.10,95%CI:1.01~1.19,交互P=0.0196)。结论 入室血糖与AMI 28 d死亡率近似U性关系,并且入室血糖是重症AMI患者短期死亡的独立预测因素。Objective To discuss the influence of blood sugar level at enter time of intensive care unit(ICU) on short-term prognosis in patients with severe acute myocardial infarction(AMI). Methods The clinical materials were retrospectively analyzed in AMI patients from the database of Medical Information Mart for Intensive Care Ⅳ(MIMIC-Ⅳ), and clinical data and laboratory indexes were collected. All patients were received ICU-entering blood sugar detection and had results. The major end-point event was 28 d mortality after hospitalization. The risk factors influencing mortality were analyzed by using single-factor and multi-factor Logistic regression analysis in AMI patients. The relationship between blood sugar and 28 d mortality was analysis by using Lowess curve, and value of blood sugar to AMI patients complicated by diabetes and to AMI patients without diabetes was analyzed through subgroup analysis. Results ICU-entering blood sugar was an independent risk factor of 28 d mortality in AMI patients(OR=1.09, 95%CI: 1.03~1.05, P=0.005). The results of Lowess curve analysis showed that there was a U-shaped relationship between blood sugar and 28 d mortality, and inflection point was 5.39 mmol/L(P<0.001).When blood sugar<5.39 mmol/L, 28-d mortality decreased gradually as blood sugar increased(OR=0.50, 95%CI:0.31~0.79, P=0.0028), and when blood sugar>5.39 mmol/L, 28 d mortality increased gradually as blood sugar increased(OR=1.20, 95%CI: 1.15~1.25, P<0.0001). The results of subgroup analysis showed that blood sugar had less influence on 28 d mortality in AMI patients complicated by diabetes compared with those without diabetes(OR=1.23, 95%CI: 1.016~1.30 vs. OR=1.10, 95%CI: 1.01~1.19, mutual P=0.0196). Conclusion There is a U-shaped relationship between ICU-entering blood sugar and 28 d mortality, and ICU-entering blood sugar is an independent predictive factor for short-time death in patients with severe AMI.

关 键 词：血糖 急性心肌梗死 短期预后 

分 类 号：R542.22[医药卫生—心血管疾病]