急性高血糖对老年急性心肌梗死患者预后的影响

Influence of acute hyperglycemia on the prognosis of elderly patients with acute myocardial infarction

目的探讨入院时高血糖对老年急性心肌梗死(AMI)患者住院期间预后的影响。方法不伴糖尿病的老年AMI患者490例,根据入院时血糖水平分为3组,正常组223例,血糖水平<6.1 mmol/L;轻度增高组150例,血糖水平6.1～7.8 mmol/L;高血糖组117例,血糖水平>7.8 mmol/L。对3组患者一般临床资料、主要并发症和病死率进行比较。结果高血糖组女性患者比例较多,与正常组和轻度增高组比较,差异有统计学意义(P<0.05);高血糖组患者肌酸激酶,肌酸激酶同工酶峰值高、血压低、心率快,与正常组和轻度增高组比较,差异有统计学意义(P<0.05);高血糖组患者住院期间病死率19.66%,与正常组和轻度增高组的8.07%、14.67%比较,差异有统计学意义(P<0.05);高血糖组住院期间并发症发生率较正常组和轻度增高组增高(P<0.05)。结论急性高血糖可能是不伴糖尿病的老年AMI患者预后不良的标志之一。

Objective To explore the influence of hyperglycemia on the prognosis of the elderly patients with acute myocardial infarction （AMI） during hospital stay. Methods 490 aged AMI pa tients without diabetes were divided into 3 groups according to the blood glucose level on admission. Group Ⅰ included 223 cases with blood glucose 〈6.1 mmol/L,group Ⅱ included 150 cases with blood glucose between 6.1 and 7.8 mmol/L,and group Ⅲ included 117 cases with blood glucose 〉7.8 mmol/L. The basic clinical data,the main complication and the in-hospital mortality of the patients in the three groups were compared. Results Compared with the other two groups, the patients in the group Ⅲ had higher female number, higher concentrations of serum creatine phosphate kinase and serum creatine phosphate kinase isoenzymes and higher heart rates,but low er blood pressure,and the differences were significant. The in-hospital mortality in group Ⅲ was 19.66% ,and in group Ⅱ and group Ⅰ was 14. 67% and 8.07% respectively, the difference was significant. The difference of the incidence rates of cardiac shock and severe arrhythmia between group Ⅲ and group Ⅰ or group Ⅱ was significant. The incidence rates of heart failure showed significant difference between group Ⅲ and group Ⅰ Conclusion Hyperglycemia may be one of the important markers of poor prognosis in the elderly non-diabetic patients with AMI.