老年急性心肌梗死患者介入治疗后ST段回落与血糖和肌钙蛋白的相关性

Association of admission hyperglycemia with ST-segment resolution and troponin T levels after primary percutaneous coronary intervention for elderly patients with acute myocardial infarction

目的观察老年急性心肌梗死患者入院时血糖水平对其经皮冠状动脉血运重建术（PCI）后ST段回落程度和肌钙蛋白T（cTNT）峰值的影响。方法收集1996--2007年收治的412例行急诊PCI治疗的首次急性心肌梗死老年患者的临床资料并进行分析，根据患者入院后首次空腹血糖水平分为3组：〈7．0mmol／L组、7．0～11．1mmol／L组和〉11．1mmol／L组。观察患者血糖与PCI术后90minST段回落程度和血清cTNT峰值的相关性。结果血糖〉11．0mmol／L组PCI术后3hST段回落〉70％患者较血糖〈7．0mmol／L组显著减少（18．0％与51．5％，P〈0．01），血糖7．O～11．1mmol／L组PCI术后3hST段回落30％～70％与血糖水平的高低无相关性；PCI再灌注治疗后，ST回落〉70％的患者cTNT水平低于ST回落〈30％的患者，分别为（0．033士0．018）ng／L和（O．107±0．055）ng／L，二者比较差异有统计学意义（P〈0．05）；Logistic回归分析显示，入院时血糖水平与cTNT水平呈正相关，入院时血糖水平越高，血清cTNT升高越明显，其中血糖〉11．1mmol／L组cTNT升高与血糖的相关性较显著（r=0．399，P〈0．01〉。结论老年急性心肌梗死患者行PCI后，血糖水平直接影响ST段回落程度和cTNT峰值，控制血糖对老年急性心肌梗死患者行PCI后有效的心肌再灌注具有重要意义。

Objective To investigate the effect of the elevated glucose level on ST- segment resolution （STR） and peak levels of troponin T in elderly patients with acute myocardial infarction （AMI） treated with primary percutaneous coronary intervention（PCI）. Methods From January 1996 to January 2007, a total of 412 elderly patients with AMI who underwent primary PCI were enrolled in the study, and divided into following groups according to the level of glucose in admission ： 〈7.0 mmol/L group, 7.0-11.1 mmol/L group and 〉11.1 mmol/L group. The association of the elevated glucose level with STR and peak levels of troponin T was investigated. Results Compared with glucose level 〈7.0 mmol/L group, patients in 〉11.1 mmol/L group had less complete STR 70% （18.0% vs. 51.5%, P〈0.01）, and there was no relationship between 30%-70% STR and glucose level. Level of troponin T in 〉70% STR group was lower than in 〈 30% STR group [（0. 033±0. 018） vs. （0. 107 ±0. 055）ng/L, P〈0. 05）. Logistic regression analysis showed that admission glycemia was correlated with peak level of troponin T. This relationship was most significant in 〉11.1 mmol/L group （r= 0. 399 , P〈0.01）. Conclusions The study shows a strong association of admission hyperglycemia with STR and peak level of troponin T in elderly patients with AMI after PCI.