老年急性心肌梗死患者入院即刻血糖水平与住院期间心功能的关系

Blood glucose level at admission as a predictor for in-hospital cardiac function in elderly acute myocardial infarction patients

目的探讨老年急性心肌梗死（AMI）患者入院即刻血糖对住院期间心功能的影响。方法连续入选从2009年1月到2010年8月间因初发AMI在首都医科大学电力教学医院心内科住院的老年患者93例，根据患者入院时即刻血糖水平三分位数进行分组，A组：血糖水平处于最小三分位者（入院即刻血糖〈7．69mmol／L）；B组：血糖水平处于中间三分位者（7．69mmol／L≤入院即刻血糖〈11．36mmol／L）；C组：血糖水平处于最高三分位者（入院即刻血糖≥11．36mmol／L）。分析三组患者心功能情况。结果C组患者心功能分级明显高于A组和B组患者[（2．84±1．02）VS（1．81±0．67）和（2．12±0．96），P〈0．01]。B组和C组患者心律失常发生率明显高于A组患者（41．9％VS35．5％和9．7％，P〈0．05）。多分类logistic回归分析显示男性性别（OR=0．339，95％C10．122～0．938，P=0．037）、入院时心率（OR=1．034，95％CI1．006-1．062，P=0．018）、CK—MB峰值（OR=I．007，95％CI1．002-1．011，P=0．003）、入院即刻血糖（0R=1．117，95％CI1．035—1．208，P=0．005）是心功能的影响因素。结论入院即刻高血糖是老年AMI患者住院期间较差心功能的预测指标。

Objective To investigate the effects of blood glucose level at admission on in-hospital cardiac function in elderly acute myocardial infarction patients. Methods A total of 93 consecutive elderly patients hospitalized for first attack of acute myocardial infarction from January 2009 to August 2010 were enrolled. They were divided into 3 groups according to tertiles of the distribution of glucose level at admission： 〈 7.69mmol/L （group A）, 7.69-11.36mmol/L （group B）, t〉 l l.36mmol/L（group C）. The cardiac function was analyzed. Results Killip class was higher in group C than in group A and B[（2.84 ± 1.02） vs （1.81 ± 0.67） and （2.12 ± 0.96）, P 〈 0.01]. Incidence of arrhythmia was significantly higher in group B and C than in group A[（41.9% vs 35.5% and 9.7%, P 〈 0.05]. Ordinal logistic regression analysis demonstrated that male（OR=0.339, 95%CI 0.122-0.938, P=0.037）, heart rate at admission（OR=l.034, 95%CI 1.006-1.062, P=0.018）, peak CK-MB（OR=1.007, 95%CI 1.002-1.011, P=0.003） and blood glucose level at admission（OR=1.117, 95%CI 1.035-1.208, P=0.005） were independent predictors of cardiac function. Conclusion In elderly patients with acute myocardial infarction, hyperglycemia at admission is predictive of poor cardiac function.