应激性高血糖比值对非糖尿病急性ST段抬高型心肌梗死患者院内死亡的影响  

Effect of stress hyperglycemic ratio on in-hospital death in patients with non-diabetic acute ST-segment elevation myocardial infarction

作　　者：郭雯[1] 朱佳佳[1] 康云鹏[1] 任燕龙[1] 李江[1] 刘文娴[1] GUO Wen;ZHU Jiajia;KANG Yunpeng;REN Yanlong;LI Jiang;LIU Wenxian(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科,100029

出　　处：《心肺血管病杂志》2023年第2期107-112,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨应激性高血糖比值(SHR)对非糖尿病急性ST段抬高型心肌梗死(STEMI)患者院内死亡及主要心脑血管不良事件(MACCE)的预测价值。方法:本研究回顾分析了2015年1月至2020年1月,首都医科大学附属北京安贞医院诊断STEMI的非糖尿病患者。收集临床资料,计算SHR,根据患者院内死亡及MACCE事件分为死亡组及存活组,MACCE组及非MACCE组,其中MACCE的定义为全因死亡、急性脑梗死、心肌梗死机械并发症、心源性休克。采用Logistic回归方法分析影响患者死亡及MACCE事件的危险因素,并采用受试者工作特征(ROC)曲线分析其预测价值。结果:共纳入符合标准的患者1164例,死亡组年龄、心率、多支病变比例、主动脉内球囊反博(IABP)使用率、谷草转氨酶、肌酐、入院即刻血糖、SHR、hs-CRP、BNP显著高于存活组(P<0.05),男性比例、急诊血运重建率、HGB、白蛋白、LVEF显著低于存活组(P<0.05)。MACCE组年龄、心率、IABP使用率、WBC、AST、肌酐、即刻血糖、SHR、hs-CRP、BNP、cTnI显著高于非MACCE(P<0.05),收缩压、白蛋白、TG、LVEF显著低于非MACCE组(P<0.05)。Logistic回归分析结果提示,SHR水平升高是非糖尿病STEMI患者院内死亡的独立危险因素(OR=24.67,95%CI:3.30~260.78,P=0.003),同时也是院内MACCE的独立危险因素(OR=3.38,95%CI:1.58~7.22,P=0.002),均较入院即刻血糖有更好的预测价值。ROC曲线分析结果显示,SHR(AUC=0.895,95%CI:0.821~0.970),(P<0.001)对非糖尿病STEMI患者死亡具有一定的预测价值,其最佳cut-off值为1.18;SHR(AUC=0.724,95%CI:0.661~0.786,P<0.001)预测非糖尿病STEMI患者院内MACCE具有一定的预测价值。结论:SHR是非糖尿病STEMI患者院内死亡及MACCE事件的独立危险因素,对其死亡及发生MACCE事件具有预测价值。Objective:To investigate the predictive value of stress hyperglycemia ratio(SHR)on nosocomial death and major adverse cardiovascular and cerebrovascular events(MACCE)in patients with non-diabetic acute ST-segment elevation myocardial infarction(STEMI).Methods:This study reviewed non-diabetic patients diagnosed with STEMI at Beijing Anzhen Hospotal,Capital Medical University from January 2015 to January 2020.Clinical data were collected,SHR was calculated,and patients were divided into death group,survival group,MACCE group,and non-MACCE group according to in-hospital death and MACCE events.Clinical data were collected,SHR was calculated,and patients were divided into death group,survival group,MACCE group,and non-MACCE group according to in-hospital death and MACCE events.MACCE was defined as all-cause death,acute cerebral infarction,mechanical complications of myocardial infarction,and cardiogenic shock.Logistic regression was used to analyze the risk factors for death and MACCE.The receiver operating characteristic(ROC)curve was used to analyze its predictive value.Results:A total of 1164 patients who met the inclusion criteria were included in this study.Age,heart rate,multi-vessel disease,IABP using,aspartate aminotransferase,creatinine,immediate blood glucose,SHR,hsCRP and BNP in the death group were significantly higher than those in survival group(P<0.05).While male proportion,emergency revascularization rate,hemoglobin,albumin and LVEF were significantly lower than those in the survival group(P<0.05).And age,heart rate,IABP using,WBC,aspartate aminotransferase,creatinine,immediate blood glucose,SHR,hs-CRP,BNP,and cTnI in MACCE group were significantly higher than those in the non-MACCE group(P<0.05).While systolic blood pressure,albumin,TG and LVEF were significantly lower than those in non-Macce group(P<0.05).Logistic regression analysis indicated that elevated SHR level was an independent risk factor for nosocomial death in non-diabetic STEMI patients(OR=24.67,95%CI:3.30-260.78,P=0.003)and for nosocomia

关 键 词：急性ST段抬高型心肌梗死 非糖尿病 应激性高血糖比值 院内结局 

分 类 号：R54[医药卫生—心血管疾病]