急性冠状动脉综合征患者糖代谢异常的临床分析

Clinical evaluation of glycometabolic disturbance in patients with acute coronary syndrome

目的了解急性冠状动脉综合征(ACS)患者糖代谢异常的状况,探讨ACS患者48小时内、1周后的糖代谢异常状况是否有一致性以及糖代谢异常、糖化血红蛋白(HbA1c)与ACS患者左心功能的相关性。方法入选2012年1月至2013年2月因ACS入住本院心脏监护病房,既往无糖尿病病史的94例患者。按照ACS的定义分为3组:不稳定型心绞痛、非ST段抬高型心肌梗死、ST段抬高型心肌梗死。入院时抽取随机血糖,进而在发病的48小时内、1周后分别做简化的口服葡萄糖耐量试验(OGTT),入院48小时内抽取HbA1c,比较3组患者血糖水平的变化。结果根据48小时内的OGTT结果显示,糖代谢异常患者72例(76.5%),包括新诊断的糖尿病患者27例(28.7%),糖调节受损(impaired glucose regulation,IGR)患者45例(47.8%)。根据1周后的OGTT结果显示,糖代谢异常患者66例(70.2%),包括新诊断的糖尿病患者23例(24.5%),IGR患者43例(45.7%)。经比较糖代谢异常患者减少6例(6.3%),包括糖尿病患者减少4例(4.2%),IGR患者减少2例(2.1%)。糖代谢状况的前后变化差异无显著性(P>0.05),仅有极少数患者糖代谢状况在1周后有所好转。糖代谢异常、HbA1c与ACS患者左心收缩、舒张功能有显著相关性(P<0.05)。结论无糖尿病病史的ACS患者,糖代谢异常普遍存在,ACS患者48小时内、1周后的糖代谢异常状况有一致性,随着梗死程度的加重和梗死面积的扩大,应激也可能参与了糖代谢异常的形成。ACS患者的糖代谢异常、HbA1c水平与左心收缩、舒张功能存在显著相关性。

Objective To investigate the prevalence of glycometabolic disturbance in patients with ACS, and to assess the consistency between the OGTT results collected in 48 hours and 1 week after the clinical event in patients with ACS, and the correlations between glycometabolic disturbance, HbA1c and cardiac function in patients with ACS. Methods 94 patients with ACS but without previous DM, who were admitted to CCU from January 2012 to February 2013, were included. According to the deifnition of ACS, 94 patients were divided into three groups:unstable angina, non-ST-segment elevation myocardial infarction, ST-segment elevation myocardial infartion. Blood glucose level were tested in admission, simplified OGTT tests were conducted within 48 hours and 1 week after the coronary artery event, HbA1c was tested within 48 hours after the clinical event. The blood glucose levels were compared among the three groups. Results According to the OGTT results collected in 48 hours, glycometabolic disturbance was seen in 72/94 patients (76.5%), the prevalences of newly diagnosed DM and impaired glucose regulation (IGR) were 28.7%(27 patients) and 47.8% (45 patients) respectively. According to the OGTT results collected 1 week after the clinical event, glycometabolic disturbance was seen in 66/94 patients (70.2%), the prevalences of newly diagnosed DM and IGR were 24.5%(23 patients) and 45.7%(43 patients) respectively. Compared with that collected in 48 hours,&nbsp;patients with glycometabolic disturbance were reduced by 6.3%(6 patients), including newly diagnosed DM in 4 patients (4.2%) and IGR in 2 patients (2.1%). The overall change of glycometabolic disturbance within one week was not statistically signiifcant (P>0.05), indicated that the glycometabolic status had improved only in a few patients within one week. Signiifcant correlations between glycometabolic disturbance, HbA1c and left heart systolic, diastolic function in patients with ACS were observed (P<0.05). Conclusion Newly diagnosed DM and IGR was common in patients with ACS and without previous DM history. The OGTT results collected in 48 hours were consistent with that collected 1 week after the clinical event in patients with ACS. With the aggravation of infarct extent and the expansion of infarct area, stress may also involved in the formation of glycometabolic disturbance. The glycometabolic disturbance, HbA1c level showed signiifcant correlations with left heart systolic and diastolic function in patients with ACS.