血糖代谢水平与急性心梗预后相关性分析
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摘要
目的探讨血糖代谢对急性心肌梗死(AMI)患者的临床特征及预后的影响。方法以2016年6月-2018年6月本院收治的730例急性ST段抬高型心肌梗死并行经皮冠状动脉介入治疗的患者为研究对象,分别将糖尿病患者和无糖尿病患者分为入院随机血糖≥7.8 mmol/L的高血糖组和入院随机血糖<7.8 mmol/L的非高血糖组,糖尿病组和无糖尿病组分别有213例和517例患者。收集其临床资料和随访1年,分析血糖代谢对AMI患者的临床特征及预后的影响。结果血糖组的冠脉左主干病变的患病率高于非高血糖组,冠脉左主干病变和单支病变的患病率均高于非高血糖组的,差异有统计学意义(P均<0.05),糖尿病患者中非高血糖组和高血糖组发生的临床联合终点事件分别为9例(34.62%)和65例(34.76%),其组间差异无统计学意义(P>0.05);无糖尿病患者中非高血糖组和高血糖组发生的临床联合终点事件分别为34例(9.66%)和34例(20.60%),其组间差异有统计学意义(P<0.05)。结论 AMI合并糖尿病患者易发生应激性的高血糖,血糖对于AMI患者的预后具有重要意义,临床上应加强AMI患者的血糖控制。
Objective To investigate the effect of blood glucose metabolism on clinical features and prognosis in patients with acute myocardial infarction(AMI). Methods A total of 730 patients treated in our hospital from June 2016 to June 2018 with acute ST-segment elevation myocardial infarction and percutaneous coronary intervention were enrolled. Patients with diabetes and non-diabetes were randomly assigned. The hyperglycemia group with blood glucose ≥7.8 mmol/L and the non-hyperglycemia group with random blood glucose <7.8 mmol/L were collected and analyzed. The clinical data was collected and followed up for 1 year. The effects of blood glucose metabolism on the clinical features and prognosis of AMI patients were analyzed. Results There were 213 and 517 patients in the diabetic group and the non-diabetic group, respectively. Baseline data for admission to each group were comparable. The prevalence of left main coronary artery lesions in the blood glucose group was higher than that in the non-hyperglycemia group. The prevalence of left main coronary lesions and single-vessel lesions in the blood glucose group were higher than those in the non-hyperglycemia group, and the difference was significant(P<0.05). The clinical joint endpoints of non-hyperglycemia and hyperglycemia in diabetic patients were 9(34.62%) and 65(34.76%) respectively with no significant difference(P>0.05); the clinical joint endpoints in non-hyperglycemia group and hyperglycemia group were 34 cases(9.66%) and 34 cases(20.60%), respectively, and the differences between the groups were statistically significant(P<0.05). Conclusion Patients with AMI and diabetes are prone to stress hyperglycemia. Blood glucose is important for the prognosis of patients with AMI. It is necessary to strengthen glycemic control in patients with AMI.
Objective To investigate the effect of blood glucose metabolism on clinical features and prognosis in patients with acute myocardial infarction(AMI). Methods A total of 730 patients treated in our hospital from June 2016 to June 2018 with acute ST-segment elevation myocardial infarction and percutaneous coronary intervention were enrolled. Patients with diabetes and non-diabetes were randomly assigned. The hyperglycemia group with blood glucose ≥7.8 mmol/L and the non-hyperglycemia group with random blood glucose <7.8 mmol/L were collected and analyzed. The clinical data was collected and followed up for 1 year. The effects of blood glucose metabolism on the clinical features and prognosis of AMI patients were analyzed. Results There were 213 and 517 patients in the diabetic group and the non-diabetic group, respectively. Baseline data for admission to each group were comparable. The prevalence of left main coronary artery lesions in the blood glucose group was higher than that in the non-hyperglycemia group. The prevalence of left main coronary lesions and single-vessel lesions in the blood glucose group were higher than those in the non-hyperglycemia group, and the difference was significant(P<0.05). The clinical joint endpoints of non-hyperglycemia and hyperglycemia in diabetic patients were 9(34.62%) and 65(34.76%) respectively with no significant difference(P>0.05); the clinical joint endpoints in non-hyperglycemia group and hyperglycemia group were 34 cases(9.66%) and 34 cases(20.60%), respectively, and the differences between the groups were statistically significant(P<0.05). Conclusion Patients with AMI and diabetes are prone to stress hyperglycemia. Blood glucose is important for the prognosis of patients with AMI. It is necessary to strengthen glycemic control in patients with AMI.
引文
[1] 刘鸿玲.急性心梗行直接冠脉介入术中再灌注性心律失常的临床特点及预后的影响[J].心血管康复医学杂志,2017,26(1):94-97.
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[8] 徐伟豪,郭文杰.糖尿病对急性心肌梗死患者PCI术后远期生存的影响[J].解放军医药杂志,2017,29(3):57-61.
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[10] 刘素勤,孟隽.急性心肌梗死并存糖代谢异常病人预后分析及护理[J].中国实用神经疾病杂志,2011,14(20):57-58.
[11] 曹树军,程国杰,马莉,等.急性ST段抬高心肌梗死合并糖代谢异常患者的临床特征和预后分析[J].中国现代医药杂志,2012,14(9):32-35.
[12] Sarkar S,Paul BK,Chakraborty PK,et al.Association between Metabolic Syndrome and Acute Myocardial Infarction[J].Mym Med J,2016,25(4):628-634.
[13] 孔强,张迎花,华琦,等.合并心脏瓣膜钙化的急性心肌梗死患者的临床特征及预后分析[J].中国心血管杂志,2016,21(4):262-267.
[14] Indradevi S,Ilavenil S,Kaleeswaran B,et al.Ethanolic extract of Crinum asiaticum,attenuates hyperglycemia-mediated oxidative stress and protects hepatocytes in alloxan induced experimental diabetic rats[J].Journal of King Saud University-Science,2012,24(2):171-177.
[15] Selvin E,Marinopoulos S,Berkenblit G,et al.Meta-Analysis:Glycosylated Hemoglobin and Cardiovascular Disease in Diabetes Mellitus[J].Ann Intern Med,2005,141(6):421-431.
[16] 中国心脏调查组.中国住院冠心病患者糖代谢异常研究--中国心脏调查[J].中华内分泌代谢杂志,2006,41(1):7-10.
[17] 赵兴胜,苏布道.心血管疾病与糖代谢异常[J].中国心血管病研究,2009,7(6):465-467.
[18] 蔡琦,顾凯,王连生,等.糖代谢异常对老年冠心病患者左心功能影响的超声评估[J].南京医科大学学报,2011,31(8):1212-1215.
[19] 王卫红,姚万发.老年糖代谢异常人群冠心病发病率及其危险因素[J].中国老年学杂志,2013,33(21):5314-5316.
[20] 黎巨亩,林泉根.心血管住院患者糖代谢异常状况的临床探讨[J].中国医药指南,2011,9(3):105-106.
[2] 陈礼学.急性心肌梗死行直接经皮冠状动脉介入治疗术后再灌注心律失常的临床分析[J].中国临床医生杂志,2017,45(10):48-50.
[3] Sanjuan R,Blasco ML,Martinez-Maicas H,et al.Acute myocardial infarction:high risk ventricular tachyarrhythmias and admission glucose level in patients with and without diabetes mellitus[J].Current Diabetes Reviews,2011,7(2):22-35.
[4] 赵丽军,梁明,李晶,等.急性心肌梗死合并糖尿病患者急诊经皮冠状动脉介入治疗围术期应用比伐芦定的安全性与有效性:BRIGHT研究预设亚组分析[J].中国介入心脏病学杂志,2016,24(9):481-486.
[5] Malfitano C,Barboza CA,Mostarda C,et al.Diabetic hyperglycemia attenuates sympathetic dysfunction and oxidative stress after myocardial infarction in rats[J].Cardiovascular Diabetology,2014,13(1):1-9.
[6] 王翠柳,卿立金.糖尿病与非糖尿病急性心肌梗死早期临床特征分析[J].中国中医急症,2016,25(2):344-346.
[7] 李秀姿,廖衍强,吕庆良.急性心肌梗死早期糖尿病与非糖尿病者血脂水平[J].中国实用医药,2015,15(21):51-52.
[8] 徐伟豪,郭文杰.糖尿病对急性心肌梗死患者PCI术后远期生存的影响[J].解放军医药杂志,2017,29(3):57-61.
[9] Yahagi K,Kolodgie FD,Lutter C,et al.Pathology of Human Coronary and Carotid Artery Atherosclerosis and Vascular Calcification in Diabetes Mellitus[J].Arterioscler Thromb Vasc Biol,2017,37(2):191-204.
[10] 刘素勤,孟隽.急性心肌梗死并存糖代谢异常病人预后分析及护理[J].中国实用神经疾病杂志,2011,14(20):57-58.
[11] 曹树军,程国杰,马莉,等.急性ST段抬高心肌梗死合并糖代谢异常患者的临床特征和预后分析[J].中国现代医药杂志,2012,14(9):32-35.
[12] Sarkar S,Paul BK,Chakraborty PK,et al.Association between Metabolic Syndrome and Acute Myocardial Infarction[J].Mym Med J,2016,25(4):628-634.
[13] 孔强,张迎花,华琦,等.合并心脏瓣膜钙化的急性心肌梗死患者的临床特征及预后分析[J].中国心血管杂志,2016,21(4):262-267.
[14] Indradevi S,Ilavenil S,Kaleeswaran B,et al.Ethanolic extract of Crinum asiaticum,attenuates hyperglycemia-mediated oxidative stress and protects hepatocytes in alloxan induced experimental diabetic rats[J].Journal of King Saud University-Science,2012,24(2):171-177.
[15] Selvin E,Marinopoulos S,Berkenblit G,et al.Meta-Analysis:Glycosylated Hemoglobin and Cardiovascular Disease in Diabetes Mellitus[J].Ann Intern Med,2005,141(6):421-431.
[16] 中国心脏调查组.中国住院冠心病患者糖代谢异常研究--中国心脏调查[J].中华内分泌代谢杂志,2006,41(1):7-10.
[17] 赵兴胜,苏布道.心血管疾病与糖代谢异常[J].中国心血管病研究,2009,7(6):465-467.
[18] 蔡琦,顾凯,王连生,等.糖代谢异常对老年冠心病患者左心功能影响的超声评估[J].南京医科大学学报,2011,31(8):1212-1215.
[19] 王卫红,姚万发.老年糖代谢异常人群冠心病发病率及其危险因素[J].中国老年学杂志,2013,33(21):5314-5316.
[20] 黎巨亩,林泉根.心血管住院患者糖代谢异常状况的临床探讨[J].中国医药指南,2011,9(3):105-106.