入院高血糖对急性冠状动脉综合征预后影响的探讨

Effects of admissional hyperglycemia on prognosis of acute coronary syndrome

目的初步探讨入院高血糖对急性冠状动脉综合征(ACS)预后相关因素的影响。方法109例ACS患者按血糖>7.8 mmol/L分为A组(n=68例),血糖≤7.8 mmol/L为B组(n=41例),比较两组临床情况和住院期间不良事件发生情况。以基线指标为自变量,以住院期间心血管事件发生率为因变量进行单因素分析和多元回归分析,探讨住院期间对心血管事件有显著性影响的危险因素。结果A组的心率、肌酐(Cr)、肌酸激酶同工酶(CK-MB)和肌钙蛋白I(cTnI)均高于B组,心率(116.9±10.8)次/min vs(105.1±21.2)次/min、Cr(142.0±8.9)μmol/L vs(109.0±10.1)μmol/L,CK-MB(0.38±0.01)μg/L vs(0.27±0.00)μg/L,cTnI(189.0±10.5)μg/L vs(86.0±9.8)μg/L(均P<0.01);两组心血管事件,包括心力衰竭(29.4%vs 26.8%)、心源性休克(4.4%vs 4.9%)、心律失常发生率(22.1%vs 34.1%)近期死亡发生率(2.9%vs 2.4%),差异无统计学意义(P>0.05);多元回归分析显示,心率、肌酐和血糖升高是住院期间心血管事件发生的危险因素。结论入院血糖水平升高是ACS患者风险发生的标志。为制定ACS患者强化血糖控制的安全性、可行性和有效性提供了参考。

Objective To investigate the prognostic value of admission glucose levels in patients with acute coronary syndromes（ACS）. Methods One hundred and nine cases with ACS were divided into to two groups：group A （68 cases） with glucose〉7.8 mmol/L and group 15 （41 cases） with glucose≤7.8 mmol/L. The potential risk factors, such as age, gender, history of myocardial infarction, body mass index （BMI）, pulse pressure （PP）, heart rate （ HR）, creatinine（Cr） and systolic blood pressure（SBP） or diastolic blood pressure（DBP） cardiovascular events were evaluated independently. Results Compared with that in group A, the HR, Cr, CK-MB and cTnI in group B were significantly higher, HR（116. 9±10. 8） beats/rain vs （105.1±21.2） beats/min,Cr（142.0±8. 9） μmol/L vs （109.0± 10.1） μmol/L, CK MB（0. 38±0. 01） μg/L vs （0.27±0.00）μg/L,cTnI（189.0± 10.5） μg/L vs （86.0± 9.8） μg/L（all P 〈0.01） ; cardiovascular events of two groups had no statistic significance （29.4% vs 26.8% ）, cardiogenic shock （4.4% vs 4.9%）,cardiac arrhythmia（22.1% vs 34.1%） and short-term death（2.9% vs 2.4%）（P 〉0.05）; HR, Cr and admissional hyperglycemia were the risk factors of cardiovascular events by a univariate logistic regression analysis. Conclusion Admissional hyperglycemia appears important to predict cardiovascular events on patients with ACS.