血糖对直接经皮冠状动脉介入治疗后患者心肌灌注的影响

Glucose level on admission and outcome after primary percutaneous coronary intervention in patients with acute myocardial infarction

目的观察血糖升高对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后的预后和心肌灌注影响。方法选取接受直接PCI治疗的急性ST段抬高心肌梗死患者308例,根据入院第一次随机血糖分为3组,1组<7.8MMOL/L,2组7.8～11.0MMOL/L,3组≥11.0MMOL/L。1组为血糖正常组,2、3组为血糖升高组。结果入院随机血糖高的患者,女性所占比例较高(19.2%比31.4%、37.9%,P<0.05),平均年龄较大[(58.5±11.3)岁比(61.6±11.2)岁、(63.6±11.2)岁,P<0.05)]。3组与1组相比血甘油三酯[(1.53±0.77)MMOL/L比(1.30±0.67)MMOL/L,P<0.05]浓度较高。冠状动脉造影结果中,2、3组多支血管病变较多(53.8%比72.1%、69.7%,P<005)。PCI术后梗死相关血管TIMI血流分级(TFG)3级,三组差异无统计学意义(89.7%、86.0%和86.3%,P>0.05)。血糖升高的两组,PCI术后梗死相关血管的校正TIMI帧计数(CTFC)数值高于第1组[(28.4±18.3)和(27.1±17.2)比(22.3±12.8),P<0.05],TIMI心肌灌注分级(TMPG)0～1级(30.3%和29.0%比17.3%,P<0.05)多见。PCI术后心电图分析:3组1HST段回落≥50%及3HT波倒置较1组少(56.7%比72.0%,58.3%比73.4%,P<0.05)。左室射血分数在2、3组患者明显降低[(54.9±10.0)和(54.8±10.0)比(57.9±9.0),P<0.05]。血糖≥11.0MMOL/L组30D内病死率高于血糖正常组(10.4%比2.6%,P<0.05)。结论入院随机血糖升高的急性ST段抬高心肌梗死患者,进行直接介入治疗后的心肌灌注较差,进而影响心功能,增加患者30D内病死率。

Objective To investigate the influence of elevated glucose level on epicardial/ microvascular flow and survival in patients with acute ST-segment elevation myocardial infarction （STEMI） treated with primary percutaneous coronary intervention （PCI）. Methods A total of 308 patients with STEMI underwent primary PCI were divided into 3 groups according to the glucose level on admission： group 1, 〈7.8 mmol/L; group 2, 7.8-11.0 mmol/L, and group3, 311.0 mmol/L Results Compared with group 1, patients in the group 2 and 3 were older, had higher triglycerides levels and more 2-vessel or 3- vessel diseases. Although TIMI flow after PCI were similar among groups （ 89.7%, 86. 0% and 86. 3%, P = 〉 0. 05）, correc^d TIMI frame count （CTFC） in group 2 and group 3 were higher than that in group 1. Moreover, TIMI myocardial peffusion grade （TMPG） 0-1 grade rate post PCI was higher in group 2 and 3 （30. 3% and 29. 0% ） than that of group 1 （ 17.3%, P 〈0. 05）. There was less frequently complete ST- segment resolution （56. 7% ） and early T wave inversion （58.3%） in group 3 than that of group 1 after PCI （72. 0% and 73.4% respectively, P 〈0. 05）. Mortality rate at 30 days post PCI was significantly higher in the group 3 （ 10. 4% ） than that in the group 1 （ 2. 6%, P 〈0. 05）. Conclusion Elevated glucose level on admission in ST-segment elevation myocardial infarction patients treated with primary PCI is associated with reduced myocardial microvascular flow. Abnormal myocardial microvascular flow might contribute to the poor outcomes observed in patients with hyperglycemia on admission.