血糖控制与急性冠脉综合征患者近期预后的相关性

Relationship between glucose management and the recent prognosis of acute coronary syndrome

目的探讨血糖控制与急性冠脉综合征(ACS)近期预后的相关性。方法记录878例ACS患者基线时各指标、住院期间不良事件发生情况以及住院期间所有测得的血糖结果。(1)将878例ACS患者患者分为生存组和住院期间死亡组,组间比较临床情况。(2)全部患者按照其住院期间血糖平均值和标准差各自分为四组(四分位法),组间比较住院期间不良事件发生情况。(3)以基线指标、血糖控制指标为自变量,住院期间死亡率为因变量进行单因素分析及多元回归分析,探讨对于住院期间死亡率有显著影响的独立风险因素。结果(1)生存组与死亡组各项血糖指标均有显著性差异。(2)全部患者按随血糖变异性分组时,随血糖变异性增大住院期间不良事件发生率增加,组间差异明显。按照平均血糖分组时,结果同上。(3)多元回归分析显示血糖变异性升高是住院期间死亡的独立风险因素。结论ACS患者住院期间的血糖变异性和血糖水平均与近期预后不良相联系。临床工作中应加强对ACS患者的血糖监测和对血糖稳定性的控制。

Objective Several indices of glucose control have been shown to be the predictors of critically ill patients outcome.However,there is no information on the possible significance of variability in glucose concentration.This study explored whether the standard deviation of blood glucose concentration would independently predict mortality in ACS patients.Methods The data on characteristics of baseline and outcome of 878 patients with acute coronary syndrome（ACS）were collected,both mean and SD of blood glucose were calculated.All the 878 cases of ACS were grouped into tertiles of mean and SD of blood glucose during hospitalization,statistical assessment of the relation between these variables and hospital mortality were made.Results There were positive correlations between SD of blood glucose and the death rate during hospitalization.In addition to the mortality predicted by the mean blood glucose,the SD of blood glucose was an independent predictor of total mortality.Conclusions Glucose variability might be considered a useful additional parameter in the management of these ACS patients,hyperglycemia and glucose stability of ACS patients should be strictly controlled.