入院时糖化血红蛋白水平与糖尿病和非糖尿病ST段抬高急性心肌梗死患者心功能的关系

目的探讨入院时血清糖化血红蛋白（HbAIc）水平与糖尿病和非糖尿病ST段抬高的急性心肌梗死（STEMI）患者心功能的关系。方法分析2008年11月至2010年5月收治的154例出现症状的〈12hSTEMI患者，以入院HbA1c水平将所有患者分组：入院HbA1c〈6．5％组（42例），6．5％～8．0％组（45例），8．1％～10．0％组（36例）和〉10．0％组（31例），后三组定义为人院高HbA1c组。分析糖尿病和非糖尿病患者HbA1c水平与心功能的关系。结果与HbAIC〈6．5％的患者比较，HbA1c升高的患者左室射血分数（LVEF）显著降低（P〈0．01）；HbA1c8．1％～10．O％组和〉10．0％组心功能KillipⅣ级的患者显著增多（P〈0．05）。用协方差分析校正年龄、性别、体重指数（BMI）、血压、血脂、血糖等因素后，在HbA1c〈6．5％组、6．5％～8．0％组和8．1％～10．0％组，非糖尿病患者LVEF显著高于糖尿病患者；在HbA1c〉10．0％组显著低于糖尿病组（P〈0．05）。在全部患者、糖尿病患者和非糖尿病患者，HbA1c水平与LVEF呈负相关（P〈0．05）。结论与糖尿病患者相比，非糖尿病史的STEMI患者入院HbA1c升高很常见，并且与心功能不全显著相关。

Objective To investigate the relationship of admission serum glycosylated hemoglobin （HbAlc） concentration with cardiac function status in ST - segment elevation acute myocardial infarction （ STEMI ） patients with or without diabetes. Methods We studied 154 STEMI patients with or without diabetes hospitalized within 12 hours of sympton onset from November 2008 to May 2010. The patients with or without diabetes were divided into four different groups by the admission HbAlc： 〈6.5% （ n = 42 ）, 6. 5 % to 8.0% （ n = 47 ）, 8. 1% to 10. 0% （ n = 36 ） and 〉 10. 0 % （ n = 31 ）, the last three groups were defined as high HbAlc group. The relationships of the HbAlc concentration with cardiac function status in patients with or without diabetes were analyzed. Result The left ventricular ejection fraction （LVEF） of patients in the high HbA1 c groups were significantly lower than that in HbAlc 〈6.5% group （ P 〈 0. 01 ） ; The proportion of patients with Killip 1Vgrading was significantly higher in the HbAlc 8. 1% to 10. 0% and 〉 10. 0% groups than that in other two groups （P 〈 0. 05）. After adjusting age, sex, BMI, blood pressure（ BP）, heart rate（ HR）, serum lipid and serum glucose with covariance analysis, in the HbA1 c 〈 6. 5% , 6. 5% to 8.0% and 8. 1% to 10. 0% groups, the LVEF in patiens without diabetes were significantly higher than that in patiens with diabetes; but in HbAlc 〉 10. 0% group, were significantly lower （ P 〈 0. 05 ）. The HbAlc concentrations of the whole patients, of the patiens with diabetes and of the patiens without diabetes were all negatively correlated with LVEF （ P 〈 0. 05 ）. Conclusion Compared with the diabetes patiens, the elevated admission HbAlc concentration is common in STEMI patients without diabetes, and significantly correlated with cardiac insufficiency.