急性心肌梗死患者HbA_1c与高敏C反应蛋白、CD62p、纤维蛋白原的关系

The relationship of HbA_1c with hsC-RP,CD62p and fibrinogen in patients with acute myocardial infarction

目的观察急性心肌梗死患者HbA_1c与CD62p、纤维蛋白原(Fib)与炎性因子高敏C反应蛋白(hsC-RP)的关系。方法对象选自2008年1月至2009年3月,年龄45～85岁,符合急性心肌梗死诊断标准的入院患者96例。测定HbA_1c、Fib、CHD62p与hsC-RP。同时随访6个月后的临床终点事件的发生率及这些指标和临床终点事件的相关性。结果根据HbA_1c水平将急性心肌梗死(AMI)患者分为HbA_1c增高组(35例)及HbA_1c正常组(61例)。HbA_1c增高组血小板CD62p、hsC-RP、Fib显著高于HbA_1c正常组(P<0.05)。此外,所有AMI患者HbA_1c水平与hsC-RP呈正相关(r=0.37,P<0.01);所有AMI患者血小板CD62p与hsC-RP呈正相关(r=0.43,P<0.01)。HbA_1c增高组出现临床终点事件者5例,包括随访6月内的再发AMI,再住院行心肌血管重建术、住院期间及随访期间的心源性死亡者;HbA_1c正常组未出现临床终点事件。随访6个月内出现临床终点事件者(5例)与无心脏事件(89例)相比,左室射血分数(P<0.01)、血hsC-RP(P<0.05)为影响临床终点事件的因素。结论 HbA_1c水平可能是影响急性心肌梗死患者病情发展及预后的重要因素。

Objective To investigate the relation of HbAa c with CD62p, high sensitive C-reactive protein （hsC-RP） and fibrinogen（Fib） level in patients with acute myocardial infarction （AMI）. Methods 96 AMI patients aged 45-85 years were prospectively enrolled. All except 2 patients were followed for 6 months. The primary outcomes were myocardial re-infarction, stroke, and death from cardiovascular causes and other reasons. AMI patients were divided into high HbA1c group （35 eases）, and normal HbA1 c group （61 cases）. Results Platelet CIM2p, hsC-RP, Fib were higher in high HbA1 c than in normal HbA1 c group （P〈0. 05）. HbA1c level was positively correlated with hoC-RP （r= 0. 37, P= 0. 002）. CD62p was positively correlated with hsC-RP （r =0. 43,P= 0. 001）. Reinfarction （n = 1）, myocardial （n= 1）, myocardial revascularization within six-month follow-up （n= 1） and cardiac death during hospitalization （n= 1） and follow-up period （n = 1） occurred in high HbAlc group and not in normal HbAlc group. The EF（P= 0.001） and hsC-RP（P= 0. 021） were the influencing factors for clinical outcome Conclusion At higher HbA1c levels, the prognosis in patients with acute myocardial infarction may be deteriorative