入院高血糖对急诊经皮冠状动脉介入后复流的影响

The effect of admission hyperglycemia on coronary reflow in primary percutaneous coronary intervention

目的评价入院血糖水平与sT段抬高型急性心肌梗死（AMI）患者急诊经皮冠状动脉（冠脉）介入治疗（PCI）后复流的相关性。方法人选2007—2010年共1413例sT段抬高型AMI并在发病24h内成功进行急诊PCI的患者，分为无复流组和复流正常组，收集所有患者的临床、冠脉造影和PCI相关的资料以评价复流现象，采用多元回归方法评价无复流的独立预测因素。结果1413例患者中发生无复流现象的患者为297例（21．0％），无复流患者入院血糖水平显著高于复流正常患者[（13．80±7．47）mmol／L比（9．67±5．79）mmol／L，P〈0．0001]，多元回归分析发现吸烟、高脂血症、再灌注时间〉6h、人院肌酐清除率〈90ml／min、PCI前使用主动脉内气囊反搏和入院血糖水平〉13．0mmoL／L是sT段抬高型AMI患者急诊PCI后无复流的独立预测因素。随着人院血糖水平的逐渐增加，无复流发生率也显著增加，血糖水平为〈7．8mmol／L和〉13．0mmol／L时，无复流发生率分别为14．6％和36．7％（P=0．009）。结论入院血糖水平〉13．0mmol／L是sT段抬高型AMI患者急诊PCI后无复流的独立预测因素。

Objective To assess the association between admission plasma glucose （APG） and no- reflow during primary percutaneous coronary intervention （PCI） in patients with ST-elevation acute myocardial infarction （STEMI）. Methods A total of 1413 patients with STEMI successfully treated with PCI were divided into no-reflow group and normal reflow group. Results The no-reflow was found in 297 patients （21.0%） of 1413 patients; their APG level was significantly higher than that of the normal reflow group [ （ 13.80 ±7.47） vs （9.67±5.79） retool/L, P 〈0. 0001 ]. Multivariate logistic regression analysis revealed that current smoking （ OR 1. 146, 95% CI 1. 026-1. 839,P =0. 031 ）, hyperlipidemia （ OR 1. 082, 95%CI1.007-1.162, P=0.032）, long reperfusion（ 〉6 h, OR 1.271, 95% C1 1.158-1.403, P= 0. 001 ） , admission creatinine clearance （ 〈 90 ml/min, OR 1. 046, 95% C1 1. 007-1. 086, P= 0. 020） , IABP use before PCI （ OR 9. 346, 95% CI 1. 314-67. 199, P = 0.026） , and APG （ 〉 13.0 mmoL/L, OR 1. 269, 95% C1 1. 156-1. 402, P = 0. 027） were the independent no-reflow predictors. The no-reflow incidence was increased as APG increased （ 14. 6% in patients with APG 〈 7.8 mmol/L and 36. 7% in patients with APG 〉 13.0 mmol/L, P = 0. 009）. Conclusion APG 〉 13.0 mmol/L is an independent no- reflow predictor in patients with STEMI and PPCI.