血糖间隙预测急性ST段抬高型心肌梗死患者pPCI治疗后住院死亡的价值  

Predictive value of glycemic gap for in-hospital mortality in patients with acute ST-segment elevation myocardial infarction undergoing pPCI

作　　者：张琦 彭秀丽 陈磊 王瑞利[1] 陈文苏 陆远 ZHANG Qi;PENG Xiuli;CHEN Lei;WANG Ruili;CHEN Wensu;LU Yuan(Department of Cardiology,the People’s Hospital of Suining County,Xuzhou,Jiangsu 221200,China;Department of Cardiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002)

机构地区：[1]睢宁县人民医院心内科,江苏徐州221200 [2]徐州医科大学附属医院心内科,江苏徐州221002

出　　处：《徐州医科大学学报》2024年第12期899-904,共6页Journal of Xuzhou Medical University

基　　金：徐州市科技发展项目重点研发计划(社会发展)资助项目(KC22268);江苏省卫生健康委面上项目(M2021046)。

摘　　要：目的探讨血糖间隙对急性ST段抬高型心肌梗死(STEMI)患者接受直接经皮冠状动脉介入治疗(pPCI)后发生住院死亡的预测价值。方法选取2018年12月10日—2022年11月10日于睢宁县人民医院行pPCI的STEMI患者566例,收集临床资料进行回顾性分析。根据是否发生住院死亡,将上述患者分为死亡组(n=26)和存活组(n=540)。采用Cox风险回归模型分析STEMI患者住院死亡的危险因素。结果在纳入研究的566例STEMI患者,有26例发生住院死亡(4.59%)。多因素Cox回归分析结果显示,血糖间隙、年龄、Killip分级、入院到导丝通过病变处(D2W)时间及C反应蛋白峰值是STEMI患者住院期间死亡的独立危险因素。受试者操作特征(ROC)曲线显示,血糖间隙预测STEMI患者住院期间发生死亡的曲线下面积(AUC)为0.724(95%CI 0.617~0.832,P<0.001)。Kaplan-Meier生存分析显示,血糖间隙大的STEMI患者住院死亡风险更高(P<0.05)。结论血糖间隙是接受pPCI治疗的STEMI患者住院死亡的独立预测因素,可作为一种简便有效的标志物用于该类患者的危险分层。Objective To investigate the predictive value of glycemic gap for in-hospital mortality in patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(pPCI).Methods A total of 566 STEMI patients who underwent pPCI at the People′s Hospital of Suining County from December 10,2018,to November 10,2022 were selected and their clinical data were collected for retrospective analysis.According to the presence of in-hospital mortality,the patients were divided into a mortality group(n=26)and a survival group(n=540).Cox proportional hazards regression was used to analyze the risk factors for in-hospital mortality in STEMI patients.Results Among the 566 STEMI patients included in the study,26(4.59%)died during hospitalization.Multivariate Cox regression analysis showed that glycemic gap,age,Killip classification,door-to-wire(D2W)time,and peak C-reactive protein(CRP)levels were independent risk factors for in-hospital mortality in STEMI patients.The receiver operating characteristic(ROC)curve indicated that the area under the curve(AUC)for glycemic gap in predicting in-hospital mortality in STEMI patients was 0.724(95%CI:0.617-0.832,P<0.001).Kaplan-Meier survival analysis revealed that STEMI patients with higher glycemic gap levels had a significantly increased risk of in-hospital mortality(P<0.05).Conclusions Glycemic gap is an independent predictor of in-hospital mortality in STEMI patients undergoing pPCI.It can serve as a simple and effective marker for risk stratification in this patient population.

关 键 词：心血管病 血糖间隙 急性ST段抬高型心肌梗死 直接经皮冠状动脉介入治疗 住院死亡 

分 类 号：R541.4[医药卫生—心血管疾病]