空腹血糖与急性心肌梗死患者经皮冠状动脉介入术后非罪犯血管病变进展的相关性研究
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摘要
目的探讨空腹血糖与急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)术后非罪犯血管病变(NCL)进展的相关性。方法收集2016年1月至2017年12月于首都医科大学附属北京安贞医院诊断AMI并于2018年6月前于本院再次住院复查冠状动脉造影的192例患者的临床资料。根据随访的冠状动脉造影情况,将患者分为NCL进展组(82例)及NCL无进展组(110例)。比较2组一般资料,并分析空腹血糖与NCL进展的相关性。结果 NCL进展组体重指数、血肌酐、空腹血糖、糖化血清白蛋白、糖化血红蛋白、同型半胱氨酸水平明显高于NCL无进展组,差异均有统计学意义(均P <0. 05)。空腹血糖水平(比值比=1. 274,95%置信区间:1. 077～1. 505,P=0. 005)及血肌酐水平(比值比=1. 020,95%置信区间:1. 002～1. 038,P=0. 027)可独立预测AMI患者PCI术后NCL的进展。空腹血糖与NCL进展呈正相关(r=0. 231,P=0. 001)。以空腹血糖为5. 715 mmol/L为界值预测NCL进展最佳,其敏感度和特异度分别为74. 4%及46. 4%。结论在临床工作中空腹血糖预测NCL进展对AMI患者PCI术后危险分层及预后具有一定指导意义,PCI术后患者应定期复查危险因素相关指标,根据具体情况控制达标,以延缓NCL的进展并改善预后及生存质量。
Objective To analyze the relation between fasting blood glucose and nonculprit vessel lesion( NCL) progression after percutaneous coronary intervention( PCI) in patients with acute myocardial infarction( AMI). Methods Clinical data of 192 patients who were diagnosed of AMI from January 2016 to December 2017 and had reexamination of coronary angiography before June 2018 in Beijing Anzhen Hospital,Capital Medical University were analyzed. They were divided into NCL progression group( 82 cases) and NCL progression-free group( 110 cases). Basic information and the correlation between fasting blood glucose and NCL progression were analyzed. Results Levels of body mass index,serum creatinine,fasting blood glucose,glycated serum albumin,glycated hemoglobin and homocysteine in NCL progression group were significantly higher than those in NCL progression-free group( all P < 0. 05). Logistic regression showed that fasting blood glucose( odds ratio = 1. 274,95% confidence interval: 1. 077-1. 505,P = 0. 005) and serum creatinine( odds ratio = 1. 020,95% confidence interval: 1. 002-1. 038,P = 0. 027) were independent predictors of NCL progression. Partial correlation analysis showed that fasting blood glucose was positively correlated with NCL progression( r = 0. 231,P = 0. 001). Receiver operating characteristic curve showed that the boundary point of fasting blood glucose to predict NCL progression was 5. 715 mmol/L; the sensitivity was 74. 4% and the specificity was 46. 4%. Conclusion Fasting blood glucose is valuable in the prediction of NCL progression and risk stratification after PCI in patients with AMI.
Objective To analyze the relation between fasting blood glucose and nonculprit vessel lesion( NCL) progression after percutaneous coronary intervention( PCI) in patients with acute myocardial infarction( AMI). Methods Clinical data of 192 patients who were diagnosed of AMI from January 2016 to December 2017 and had reexamination of coronary angiography before June 2018 in Beijing Anzhen Hospital,Capital Medical University were analyzed. They were divided into NCL progression group( 82 cases) and NCL progression-free group( 110 cases). Basic information and the correlation between fasting blood glucose and NCL progression were analyzed. Results Levels of body mass index,serum creatinine,fasting blood glucose,glycated serum albumin,glycated hemoglobin and homocysteine in NCL progression group were significantly higher than those in NCL progression-free group( all P < 0. 05). Logistic regression showed that fasting blood glucose( odds ratio = 1. 274,95% confidence interval: 1. 077-1. 505,P = 0. 005) and serum creatinine( odds ratio = 1. 020,95% confidence interval: 1. 002-1. 038,P = 0. 027) were independent predictors of NCL progression. Partial correlation analysis showed that fasting blood glucose was positively correlated with NCL progression( r = 0. 231,P = 0. 001). Receiver operating characteristic curve showed that the boundary point of fasting blood glucose to predict NCL progression was 5. 715 mmol/L; the sensitivity was 74. 4% and the specificity was 46. 4%. Conclusion Fasting blood glucose is valuable in the prediction of NCL progression and risk stratification after PCI in patients with AMI.
引文
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[12]Katakami N.Mechanism of development of atherosclerosis and cardiovascular disease in diabetes mellitus[J].J Atheroscler Thromb,2018,25(1):27-39.DOI:10.5551/jat.RV17014.
[2]Park MW,Seung KB,Kim PJ,et al.Long-term percutaneous coronary intervention rates and associated independent predictors for progression of nonintervened nonculprit coronary lesions[J].Am J Cardiol,2009,104(5):648-652.DOI:10.1016/j.amjcard.2009.04.052.
[3]Zheng JL,Lu L,Hu J,et al.Increased serum YKL-40 and C-reactive protein levels are associated with angiographic lesion progression in patients with coronary artery disease[J].Atherosclerosis,2010,210(2):590-595.DOI:10.1016/j.atherosclerosis.2009.12.016.
[4]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华心血管病杂志,2011,39(7):579-616.DOI:10.3760/cma.j.issn.0253-3758.2011.07.002.Revision commission of Chinese guidelines for the management of hypertension.2010 Chinese guidelines for the management of hypertension[J].Chinese Journal of Cardiology,2011,39(7):579-616.DOI:10.3760/cma.j.issn.0253-3758.2011.07.002.
[5]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.DOI:10.3760/cma.j.issn.1674-5809.2018.01.003.Chinese Diabetes Society.Chinese guidelines for the management of type 2 diabetes mellitus(2017)[J].Chinese Journal of Diabetes Mellitus,2018,10(1):4-67.DOI:10.3760/cma.j.issn.1674-5809.2018.01.003.
[6]Grupa Robocza Europejskiego Towarzystwa Kardiologicznego(ESC),Rydén L,Grant PJ,et al.ESC guidelines on diabetes,pre-diabetes and diseases of the cardiovascular system developed in cooperation with the EASD[J].Kardiol Pol,2013,71 Suppl 11:S319-394.DOI:10.5603/KP.2013.0289.
[7]Khan I,Siddiqui AH,Singhal S,et al.Glycaemic status in patients of acute myocardial infarction:a detailed analysis[J].Diabetes Metab Syndr,2016,10(1 Suppl 1):S140-143.DOI:10.1016/j.dsx.2015.09.026.
[8]Berry C,Noble S,Grégoire JC,et al.Glycaemic status influences the nature and severity of coronary artery disease[J].Diabetologia,2010,53(4):652-658.
[9]Langouche L,Van den Berghe G.Glucose metabolism and insulin therapy[J].Crit Care Clin,2006,22(1):119-129,vii.
[10]章祎.应激性高血糖对非糖尿病急性心肌梗死患者预后的影响[J].中国医药,2011,6(8):902-904.DOI:10.3760/cma.j.issn.1673-4777.2011.08.003.Zhang Y.Impact of stress-hyperglycemia on prognosis in non-diabetic patients with acute myocardial infarction[J].China Medicine,2011,6(8):902-904.DOI:10.3760/cma.j.issn.1673-4777.2011.08.003.
[11]Bartnik M,Rydén L,Ferrari R,et al.The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe.The Euro Heart Survey on diabetes and the heart[J].Eur Heart J,2004,25(21):1880-1890.
[12]Katakami N.Mechanism of development of atherosclerosis and cardiovascular disease in diabetes mellitus[J].J Atheroscler Thromb,2018,25(1):27-39.DOI:10.5551/jat.RV17014.