女性急性心肌梗死患者入院时血糖水平与预后关系的研究

Relationship between blood gluocose level on admission and prognosis in female patients with acute myocardial infarction.

目的探讨入院时高血糖对女性急性心肌梗死（AMI）患者住院期间预后的影响。方法对我院心脏内科1988年1月至2007年12月接诊的171例无糖尿病史的女性急性AMI患者根据其入院时血糖水平分为3组。第Ⅰ组：69例，血糖水平〈6．1mmol／L；第Ⅱ组：49例，血糖水平6．1～7．8mol／L；第Ⅲ组：53例，血糖水平〉7．8mmol／L。对3组患者的一般临床情况、梗死部位、主要并发症发生率和病死率进行比较。结果①3组患者在一般临床情况、梗死部位方面差异无统计学意义（P均〉0．05）；②第Ⅲ组患者住院期间心力衰竭、心源性休克、严重心律失常发生率明显高于第Ⅰ组、第Ⅱ组患者[心力衰竭发生率：第1组30．43％（21／69），第Ⅱ组32．65％（16／49），第Ⅲ组58．49％（31／53）；心源性休克发生率：第Ⅰ组5．80％（4／69），第Ⅱ组8．16％（4／49），第Ⅲ组24．53％（13／53）；严重心律失常发生率：第Ⅰ组24．64％（17／69），第Ⅱ组30．61％（15／49），第Ⅲ组54．72％（29／53）]，差异均有统计学意义（P均〈0．05）。第Ⅲ组患者院内病死率[28．30％（15／53）]显著高于第1组[13．04％（9／69）]患者，差异有统计学意义（P〈0．05）。结论女性AMI患者入院血糖水平增高时，住院期间心力衰竭、心源性休克、严重心律失常的发生率及病死率均明显增加。

Objective To approach the effect of hyperglycemia on admission on the prognosis in female patients with acute myocardial infarction （AMI） during hospital stay. Methods 171 female AMI patients without a history of diabetes mellitus from January 1998 to December 2007 were divided into 3 groups according to the blood glucose level on admission. Group Ⅰ included 69 cases with blood glucose 〈6.1 mmol/L,group Ⅱ included 49 cases with blood glucose between 6.1 and 7. g mmol/L,and group Ⅲ included 53 cases with blood glucose 〉7.8 mmol/ L. The basic clinical profile,infarct sites,the incidence rates of the main complications and the mortality of the patients in three groups were analyzed. Results （1）The basic clinical profile and infarct sites did not＇ show significant difference in three groups （P 〉 0.05 ）. （2）The incidence rates of cardiac failure, cardiogenic shock and severe arrhythmia among group Ⅲ,group Ⅰ and group Ⅱ were significantly different （ the incidence rate of cardiac failure was 30.43% （21/69） ,32.65% （16/49） and 58.49% （31/53） ,the incidence rate of cardiogenic shock was 5.80% （4/69） ,8.16% （4/49） and 24.53% （ 13/53 ） ; the incidence rate of severe arrhythmia was 24.64% （17/69） ,30. 61% （15/49） and 54.72% （29/53） ,respectivley in group Ⅰ ,group Ⅱ and group Ⅲ ,P 〈0.05 for each）. The inhospital mortality in group m （28.30% （15/53） ） was remarkably higher than group Ⅰ （ 13.04% （6/69）） ,with significant difference （ P 〈 0. 05 ）. Conclusions Elevated blood glucose level on admission is associated with a markedly increased risk of cardiac failure, severe arrhythmia, cardiogenic shock and mortality during hospital stay in female patients suffering from AMI.