急性冠脉综合症患者血糖异常与预后关系的研究

Study on the relationship between hyperglycemia and outcomes in patients with acute coronary syndrome

目的:探讨急性冠脉综合征(ACS)患者血糖含量异常与预后的关系。方法:对165例住院的ACS患者做标准75g口服葡萄糖实验。据血糖水平,把患者分为血糖正常组,空腹血糖异常组,餐后血糖水平增高组和糖尿病组(DM)。利用心电图和B型超声心动图检测各组中心肌梗塞及/或缺血的范围,心力衰竭发生率,以及住院期间死亡率。结果:(1)空腹血糖水平增高者为13.3%,血糖正常者及餐后2h血糖水平增高者各为22.4%,DM患者占41.8%,比例显著大于前三组(P<0.05)。全组ACS患者血糖异常总检出率为77.5%,性别间差别不显著;(2)血糖正常及空腹血糖异常者心肌梗塞及/或心肌缺血的范围差别不显著,而餐后血糖水平增高者及DM者显著大于前二组(P<0.05),但后二组差别不显著(P>0.05);(3)血糖正常组及空腹血糖水平增高组心衰的检出率基本相同,餐后血糖水平增高组的检出率虽高于前两组,但差别不显著(P>0.05)。糖尿病组心衰的检出率为65.2%,显著高于前三组(P<0.01)。心衰的总检出率为41.2%,性别间差别不显著(P>0.05);(4)住院期间DM共有5例死亡,占7.2%;余各组死亡率为零;以上各种异常检出率在性别间差别均不显著(P>0.05)。结论:ACS患者血糖异常水平与心肌梗塞及/或心肌缺血范围,心力衰竭的发生率呈正相关,餐后血糖水平增高及糖尿病患者不良事件的发生率明显增加。

Objective： To study the relationship between hyperglycemia and outcomes in the patients with acute coronary syndrome （ACS）. Methods： One hundred and sixty-five ACS patients were enrolled in this study. The patients were classified into four groups according to the oral glucose tolerance test, group Ⅰ was the normal blood sugar group, group Ⅱ was the impaired fasting glucose （IFG）, group Ⅲ was the impaired tolerance （IGT）, and the group was the diabetic mellitus （DM）. The myocardial infarction （MI） and/or ischemic extent, prevalence of heart failure were measured by electrocardiograms and B model echocardiography during the hospitalized period. Results： The prevalence of the IFG was 13.3%, IGT was 22.4%, and DM was 41.8% in the total ACS patients, the prevalence of the DM patients was higher than those of the other groups significantly （P〈0.05）; The prevalence of myocardial infarction （MD and/or ischemic extent was similar in the normal and the IFG group, but was much higher in the IGT and DM group than those of the other two groups （P〈0. 05） ; the prevalence of heart failure was 41.2% in total and 65.2% in the DM group that was much higher than those of other groups （P〈0.05）; only the DM group had 5 patients died during hospitalization period. Conclusion.. There is higher prevalence of hyperglycemia in the ACS patients and these patients have adverse outcomes during the period of hospitalization.