应激性高血糖对非糖尿病急性心肌梗死预后的影响

Stress hyperglycemia and its impact on in-hospital outcomes of patients without diabetes hospitalized with acute myocardial infarction

目的急性心肌梗死（acute myocardial infarction，AMI）常见血糖升高，其增高的程度与疾病转归相关。现以空腹血糖定义非糖尿病AMI患者的应激性高血糖，研究应激性高血糖对非糖尿病的AMI院内预后的影响。方法研究对象为南京解放军第81医院2000年1月至2010年5月收治入院的107例非糖尿病AMI患者。回顾性分析各组的院内死亡和院内并发症。排除标准：（1）年龄小于18岁；（2）有糖尿病史；（3）无糖尿病史但住院期间启动降糖治疗的患者；（4）非心血管病因的急性心肌梗死患者；（5）严重肝肾功能不全、严重肺部基础疾患、恶性肿瘤晚期患者；（6）近期使用过类固醇药物以及甲状腺机能亢进、库欣综合征等影响葡萄糖代谢疾病的患者。根据空腹血糖（fasting blood glucose，FBG）水平将其分为4组，分别是：〈7．0mmol／L，7．0～8．0mmol／L，8．0～11．1mmol／L，≥11．1mmol/L。采用Stata9．2统计软件，分别进行成组t检验、方差分析、秩和检验及确切概率法分析。对有意义的变量进行多因素logistics回归分析。结果发生应激性高血糖47例（43．9％）。FBGt〉7．0mmol／L的患者即有应激性高血糖的患者较FBG〈7．0mmol／L患者的病死率显著增高，分别是27．66％和6．67％（P=0．0063），OR=5．35（95％C／1．61～17．75，P=0．0061），肺部感染、充血性心力衰竭、严重心律失常和急性脑血管事件等院内并发症发生率也显著增高。经多因素Logistic回归分析显示FBG是AMI死亡的独立危险因素，OR=1．56（95％CI1．09～2．23）。结论有应激性高血糖的非糖尿病AMI患者死亡风险增高、院内并发症显著增多。应激性高血糖可作为判定非糖尿病AMI预后的一个较好指标。

Objective Hyperglycemia was common during acute myocardial infarction （AMI）. This study investigated the impact of stress hyperglycemia on in-hospital outcomes in patients without diabetes hospitalized with AMI. Methods The study included 107 patients with AMI without diabetes, who were admitted to 81 hospital of PLA of Nanjing, China from January 2000 to May 2010. The in-hospital mortality and in-hospital complications were analyzed retrospectively. The exclusion criteria were： （ 1 ） patients 〈 18 years old ; （2） patients with history of diabetes ; （ 3 ） patients who initiated anti-hyperglycemic therapy during their hospital stay though without previously diagnosed diabetes; （4） patients with non-cardiovascular causes for AMI; （5） patients with hepatic failure, kidney failure, serious lung illnesses and end stage of malignant tumour; （6） patients administrated with steroid treatment recently and those with some diseases which had dramatic effect on glucose metabolism such as hyperthyroidism and cushing syndrome. Patients were categorized according to FBG levels into 4 mutually exclusive groups ： 〈 7.0 mmol/L, ≥7.0 but 〈 8.0 mmol/L, 8.0 to 〈 11. lmmol/L and≥11.1 mmol/L. The Statistical Package for Stata, version 9.2 was used for statistical analysis. According to corresponding data analysis of t-test, ANOVA, rank test and exact orooability were used respectively. Univariate logistics regression analysis was conducted followed by multivariate logistics regression analysis on significant variables. Results The incidence rate of stress hyperglycemia in patients with AMI without diabetes was 43.9% （ n = 47 ）. In non-diabetic patients, the mortality of the group of FBG ≥ 7.0 mmol/L was significantly higher than the group of FBG 〈 7.0 retool/L, which are 27.66% and 6.67% （ P = 0. 0063 ） respectively, OR = 5.35 （95 % CI1.61 - 17.75, P = 0. 0061 ）. In-hospital complications for example lung infection, congestive heart failure, serious arrhythmias and acute cerebrovascular events were increased significantly in AMI patients with stress hyperglycemia. Multivariate logistic re- gression analysis for mortality were performed adjusting for risk factors which demonstrated FBG was a independent risk factors of in-hospital death , OR = 1.56 （95 % CI1.09 - 2.23）. Conclusions In-hospital mortality and in-hospital complications were significantly increased in patients with AMI without diabetes which developed stress hyperglycemia. Stress hyperglycemia was of great prognostic value for short-outcomes of AMI.