摘要
目的研究急性心肌梗死(AMI)患者空腹血糖的预后价值。方法本研究入选257例无糖尿病病史AMI患者。测量患者入院时血糖(AG)和禁食至少8h后的血糖(FG)。随访患者30d,分析AG和FG与患者预后之间的关系。结果共24(9.3%)例无糖尿病病史患者在AMI后30d内死亡。FG正常组死亡2例(1.5%),FG升高者的第一、第二、第三个三分位数组分别死亡4例(9.8%)、5例(12.2%)、13例(31%)。和FG正常组患者相比,校正后的30d死亡的相对危险比(OR)随FG三分位数的增加而增加,第一、第二和第三个三分位数组分别为:2.5(95%CI,0.71~8.5;P=0.011),8.6(95%CI,3.2~23.5;P=0.0005),12.7(95%CI,4.5~36.4;P<0.0003)。同FG和AG都正常的患者相比,AG升高FG正常预测患者30d死亡的OR为0.69(95%CI,0.25~3.80;P=0.59);AG正常FG升高者为3.6(95%CI,2.1~11.5;P=0.04);FG和AG都升高者为10.6(95%CI,4.3~25.6;P<0.0001)。镶嵌模型的比较显示AG并不能增加FG模型预测30d死亡(2=5.2,3df,P=0.20)或预测30d死亡和心力衰竭(2=4.8,3df,P=0.31)的价值。相反,FG却能增加AG模型预测30d死亡(2=24.5,3df,P=0.0001)或预测30d死亡和心力衰竭(2=24.7,3df,P=0.0001)的价值。结论无糖尿病病史AMI患者30d死亡率随AG和FG浓度的增加而增加,FG比AG的预测价值更大。
Objective To investigate the predictive value of fasting glucose concentrations on 30-day mortality in nondiabetie patients with AMI. Methods The relationship between fasting blood glucose and 30-day ease fatality was studied in 257 nondiabetie patients with acute myocardial infarction (AMI). FG (8-hour fast within 24 hours of admission) and AG were measured in each patient. Results A total of 24 (9.3%) deaths occurred in nondiabetie patients with AMI. Mortality at 30 days was 1.5% in patients with normal FG, 9.8%, 12.2%,31.0% in the first, second, and third tertiles of elevated FG, respectively. Compared with normal FG, adjusted odds ratios (OR) for 30-day fatality among those in the first second, third tertile were 2.5 (95% CI,0.71-8.5;P=0.011), 8.6(95% CI,3.2-23.5, P=0.0005), 12.7 (95% CI, 4.5-36.4,P〈0.0003) respectively. Compared with patients with normal FG and AG, the adjusted OR for 30-day mortality were 0.69 (95% CI, 0.25-3.8,P=0.59) in patients with elevated AG and normal FG, 3.6 (95% CI,2.1-11.5,P=0.04) for patients with normal AG and elevated FG, and 10.6(95% CI, 4.3-25.6,P〈0.0001) for patients with beth elevated FG and AG. Comparing nested models showed that including AG failed to improve the prediction of the model based on FG (2=4.8,3 df, P= 0.31 ). In contrast, the addition of FG classes to the model based on AG improved model prediction(2=24.7,3 df, P=0.0001 ). Conclusion There is a graded relation between elevated FG and AG and 30-day mortality in nondiabetie patients with AMI. FG is superior to AG in the assessment of 30-day mortality.
出处
《中国心血管病研究》
CAS
2007年第4期255-258,共4页
Chinese Journal of Cardiovascular Research
关键词
心肌梗塞
血糖
预后
Myocardial infarction
Blood glucose
Prognosis