空腹血糖——急性心肌梗死患者早期死亡的独立预测因子

Fasting glucose concentrations independently predict 30-day mortality in patients with acute myocardial infarction

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.