急性心肌梗死合并糖尿病患者院外血糖和血脂控制水平及其与预后相关性研究  

Study on the control status of out-of-hospital blood glucose,blood lipids and their correlation with prognosis in patients with acute myocardial infarction complicated with diabetes mellitus

作　　者：张天行 冯淑惠 韩雪雪 周星竹 夏经钢[1] Zhang Tianxing;Feng Shuhui;Han Xuexue;Zhou Xingzhu;Xia Jinggang(Department of Cardiology,Xuanwu Hospital,Capital Medical University,National Clinical Research,Center for Geriatric Diseases,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院心脏内科、国家老年疾病临床医学研究中心,北京100053

出　　处：《中国医师进修杂志》2025年第3期195-201,共7页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探究急性心肌梗死(AMI)合并糖尿病患者院外血糖和血脂控制水平及其与预后的相关性。方法回顾性分析首都医科大学宣武医院2017年1月至2022年12月406例AMI合并糖尿病患者的临床资料。记录患者人口统计学和院内外临床信息,记录院外危险因素控制水平和主要不良心脑血管事件(MACCE)发生情况。根据患者糖化血红蛋白(HbA 1c)和低密度脂蛋白胆固醇(LDL-C)水平分别进行分组。HbA 1c<6.0%为低HbA 1c组,HbA 1c 6.0%~7.0%为中HbA 1c组,HbA 1c>7.0%为高HbA 1c组;LDL-C<1.4 mmol/L为低LDL-C组,LDL-C 1.4~1.8 mmol/L为中LDL-C组,LDL-C>1.8 mmol/L为高LDL-C组。采用多因素Cox回归分析影响AMI合并糖尿病患者发生院外MACCE的独立危险因素。结果249例患者HbA 1c资料完整,HbA 1c≤7%的患者仅占51.0%(127/249),其中低HbA 1c组(24例)、中HbA 1c组(103例)和高HbA 1c组(122例)脑梗死史、院外空腹血糖、院外总胆固醇(TC)和院外LDL-C比较差异有统计学意义(P<0.05)。低HbA 1c组、中HbA 1c组和高HbA 1c组院外MACCE发生率分别为20.8%(5/24)、12.6%(13/103)和32.0%(39/122)。高HbA 1c组院外MACCE发生率明显高于中HbA 1c组,差异有统计学意义(P<0.05);低HbA 1c组与高HbA 1c组比较差异无统计学意义(P>0.05)。406例患者中,LDL-C≤1.8 mmol/L的患者占53.4%(217/406),而LDL-C<1.4 mmol/L的患者仅占20.0%(81/406)。低LDL-C组(81例)、中LDL-C组(136例)和高LDL-C组(189例)高脂血症、院外HbA 1c、院外空腹血糖、院外丙氨酸氨基转移酶(ALT)、院外TC和院外三酰甘油(TG)比较差异有统计学意义(P<0.05)。低LDL-C组、中LDL-C组和高LDL-C组院外MACCE发生率为18.5%(15/81)、25.7%(35/136)和36.5%(69/189)。高LDL-C组院外MACCE发生率明显高于低LDL-C组,差异有统计学意义(P<0.05);低LDL-C组与中LDL-C组比较差异无统计学意义(P>0.05)。在不同HbA 1c组中,多因素Cox回归分析结果显示,HbA 1c>7%和高院外空腹血糖是影响AMI合并糖尿病患者发生院外Objective To investigate the control status of out-of-hospital blood glucose and blood lipids in patients with acute myocardial infarction(AMI)complicated with diabetes mellitus and its correlation with prognosis.Methods The clinical data of 406 patients with AMI complicated with diabetes mellitus from January 2017 to December 2022 in Xuanwu Hospital,Capital Medical University were retrospectively analyzed.The demographic and out-of-hospital clinical information of patients were recorded,and the control level of out-of-hospital risk factors and the occurrence of major adverse cardiovascular event(MACCE)were also recorded.The patients were grouped according to the levels of glycosylated hemoglobin(HbA 1c)and low-density lipoprotein cholesterol(LDL-C).HbA 1c<6.0%was the low HbA 1c group,HbA 1c 6.0%to 7.0%was the medium HbA 1c group,and HbA 1c>7.0%was the high HbA 1c group;LDL-C<1.4 mmol/L was low LDL-C group,LDL-C 1.4 to 1.8 mmol/L was medium LDL-C group,and LDL-C>1.8 mmol/L was high LDL-C group.Multivariate Cox regression analysis was used to analyze the independent risk factors for out-of-hospital MACCE in patients with AMI complicated with diabetes mellitus.Results The HbA 1c data of 249 patients were recorded in detail,and only 51.0%(127/249)of patients with HbA 1c≤7%.There were statistical differences in the history of cerebral infarction,out-of-hospital fasting blood glucose,out-of-hospital total cholesterol(TC)and out-of-hospital LDL-C among the low HbA 1c group(24 cases),medium HbA 1c group(103 cases)and high HbA 1c group(122 cases)(P<0.05).The incidences of out-of-hospital MACCE in low HbA 1c group,medium HbA 1c group and high HbA 1c group were 20.8%(5/24),12.6%(13/103)and 32.0%(39/122),respectively.The incidence of out-of-hospital MACCE in high HbA 1c group was significantly higher than that in medium HbA 1c group,and there was statistical difference(P<0.05);there was no statistical difference between low HbA 1c group and high HbA 1c group(P>0.05).Among the 406 patients,53.4%(217/406)had LDL-C≤1.8 mmo

关 键 词：心肌梗死 糖尿病 血糖 血脂异常 预后 

分 类 号：R54[医药卫生—心血管疾病]