急性高血糖对ST段抬高性心肌梗死院内预后的影响

The impact of acute hyperglycemia on the prognosis of ST-segment elevation myocardial infarction

目的探讨急性高血糖对 ST 段抬高性心肌梗死(STEMI)患者院内预后的影响。方法连续入选356例北京地区17家三级和二级医院所有在24h 内入院且符合 STEMI 诊断标准的患者。以人院血糖水平>11mmol/L 判定为高血糖,分为高血糖组和血糖正常组,观察两组患者院内死亡和心血管病事件的发生情况。院内心血管事件定义为院内再发心肌梗死、新发生的心力衰竭、严重心律失常及卒中。结果 356例 STEMI 患者中,存在急性高血糖患者共81例(22.8%)。其院内病死率较无急性高血糖患者显著增加(13.6%比5.1%,P=0.009),院内心血管事件发生率亦显著增多(32.1%比20.4%,P=0.027)。logistic 回归分析示,入院急性高血糖(OR 1.615,95%CI 1.116～2.338,P=0.011)为 STEMI 患者院内不良预后的独立危险因素。结论 STEMI 急性高血糖患者院内死亡及发生院内心血管事件的危险性显著高于入院血糖正常者。入院高血糖为 STEMI 患者院内不良预后的独立危险因素。

Objective This study was undertaken to assess the effect of acute hyperglycemia on the in-hospital outcomes in patients with ST-segment elevation myocardial infarction （STEMI）. Methods Between January 2006 and July 2006, 356 patients, from 17 hospitals in Beijing were admitted to the hospitals within 24 hours after the onset of STEMI. They were divided into two groups according to the admission glucose level （ cutoff value, 11 mmol/L）. The in-hospital mortality and cardiovascular events were compared between the two groups. The in-hospital cardiovascular events were defined as in-hospital reinfarction, new-onset heart failure, malignant arrhythmia and stroke. Results There were 81 （22. 8% ） patients with acute hyperglycemia. The in-hospital mortality rate was significantly higher in patients with acute hyperglycemia than in patients without （ 13.6% VS 5. 1%, P ---0. 009）. The rate of cardiovascular events was also higher in patients with acute hyperglycemia （32. 1% VS 20. 4%, P =0. 027）. By univariate and multivariate logistic regression analysis, high blood glucose on admission （OR, 1. 615; 95% CI, 1.116- 2. 338, P = 0. 011 ） was an independent risk factor for in-hospital outcoms. Conclusion The rate of in- hospital mortality and cardiovascular events was significantly higher in STEMI patients with acute hyperglycemia than in patients without, high blood glucose on admission was an independent risk factor for in-hospital outcoms in patients with STEMI.