应激性高血糖对非糖尿病患者急性前壁AMI后发生心室重构的预测价值

The predictive value of stress hyperglycaemia in ventricular remodeling in non-diabetic patients with first anterior myocardial infarction

目的研究在急性心肌梗死(acute myocardial infarction,AMI)时的应激性高血糖与左室重构的关系。方法本研究共分析了182例无糖尿病史的前壁AMI患者。应激性高血糖的诊断标准定义为AMI次日晨起空腹血糖(FG)≥7.0 mmol/L。所有入选患者分别于住院时、出院后3个月及12月分别进行超声心动图复查。在高血糖组(SH组)EDVI及ESVI的一年变化率分别为(11.5±16.3)ml/m2和(7.1±9.8)ml/m2(P<0.000 1);而在血糖正常组ESVI及EDVI的变化率分别为(1.8±10.3)ml/m2和(0.4±8.7)ml/m2,(P=0.26);如果以EDVI变化20%为心室重构的界定值,在高血糖组有33(43%)例,血糖正常组仅15(18%)例,两组之间差异显著(P<0.001)。结果通过多变量分析确定左室重构的独立预测因素,发现两项参数与EDVI的变化独立相关,是基线时的血糖水平和LVWMSI,在这里以LVWMSI的平均值1.88为界。进一步行logistic回归分析,仅有发病时的血糖水平为左室重构的独立预测因素。结论应激性高血糖是非糖尿病患者前壁AMI后发生左室重构的独立危险因素。

Objective To study the correlation between stress hyperglycaemia in early phase of acute myocardial infarction （AMI） and ventricular remodeling. Methods A total of 182 non-diabetic patients with first anterior MI were studied, The diagnosis of stress hyperglycaemia was made on the basis of fasting glucose （FG） level ≥7.0 mmol/L in the first morning after AMI. Electrocardiogram parameters were obtained at the time of hospitalization and 3 months,12 months after discharge from hospital. The 1 year variance rate of enddiastolic volume index （EDVI） and end-systolic volume index（ESVI） were（ 11.5 ± 16.3 ） ml/m^2 and （7.1 ± 9.8 ） ml/m^2 （ P 〈 0. 000 1 ） respectively in patients with stress hyperglycaemia while those were （ 1.8 ±10.3 ） mi/m^2 and （0.4 ± 8.7 ） ml/m^2 （ P = 0.26 ） respectively in patients without stress hyperglycaemia. There were 33 （43 % ） patients with stress hyperglycaemia and 15 （18%） patients without stress hyperglycaemia were observed when LV remodeling was defined as a 〉 20% increase of EDVI （ P 〈 0. 001 ）. Results By multivariable analysis, the baseline of stress hyperglycaemia and wall motion score index （WMSI） were independently associated with changes in EDVI. Only the stress hyperglycaemia level was an independent predictor for ventricular remodeling by logistic regression analysis. Conclusion Stress hyperglycaemia is a major and independent predictor for ventricular remodeling after first anterior MI in non-diabetic patients.