急性冠状动脉综合征经皮冠状动脉介入治疗中血糖波动和不良事件的关系

The relationship between the blood sugar fluctuations and adverse events during the acute coronary syndrome percutaneous coronary intervention treatment

目的 分析急性冠状动脉综合征患者经皮冠状动脉介入治疗（PCI）术后住院期间的血糖波动与患者预后的相关性.方法 总结2009年1-12月在北京安贞医院心内科以急性冠状动脉综合征合并糖尿病入院并进行PCI治疗的患者1723例,且住院时间不少于3d,住院期间每日监测血糖不少于4次的病例资料,根据有无心血管不良事件及死亡分为不良事件组（84例）、无不良事件组（1639例）,计算2组患者PCI术后3d每天的血糖值,根据每天最高血糖与最低血糖计算术后3d的血糖最大波动幅度,计算术后3d血糖标准差及血糖最大波动幅度的均值,观察血糖波动与不良心血管事件发生及死亡的相关性.结果 不良事件组及无不良事件组术后3d平均血糖（MBG）分别为（10.6±2.2）、（11.3±1.5）mmol/L,平均血糖标准差分别为（3.6±1.4）、（1.7±0.7） mmol/L,最大血糖波动幅度分别为（11.3±3.5）、（7.6±2.4） mmol/L;2组急性冠状动脉综合征伴糖尿病患者PCI术后,MBG水平无明显差别,组间差异无统计学意义（P＞0.05）；不良事件组血糖标准差明显高于无不良事件组,组间差异有统计学意义（P＜0.05）.不良事件组日最大血糖波动幅度明显大于无不良事件组,组间差异有统计学意义（P＜0.01）.结论 提示急性冠状动脉综合征伴糖尿病患者PCI术后血糖波动可能增加不良心血管事件和病死率.

Objective To analyze the correlation of blood sugar fluctuations and prognosis of post-operative percutaneous coronary intervention （PCI） patients. Methods Totally 1723 patients admitted for PCI incorporated with diabetes and treated with PCI in the Department of Cardiology of our hospital from January to December 2009 were reviewed. According to adverse cardiovascular events and death, there were 84 patients in adverse events group and 1639 patients in no adverse events group. The blood glucose was monitored at least four times every day during the hospital stay. Based on the highest daily blood glucose and the lowest blood sugar, largest amplitude of plasma glucose excursions（ LAGE）, the standard deviation of blood sugar and means of LAGE were computed for three days after operation. The correlation of blood glucose fluctuations and numbers of adverse cardiovascular events and death was observed. Results Mean blood glucose（MBG） in adverse events group and no adverse events group was 10.7 ± 2.2 and 11.3± 1.5 respectively. The standard deviation（SD） for the two groups was 3.6 ±1.4 and 1.73± 0.7 respectively. The LAGE for the two groups was 11.3±3.5 and 7.6±2.4 respectively. There is no statistically significant difference between the two groups （ P 〉 0.05 ） in MBG ; SD of the adverse events group was higher than the no adverse events group, the difference is statistically significant （ P 〈 0.05 ）. LAGE of the adverse events group was significantly higher than that of the no adverse events group （ P 〈 0.01 ）. Conclusion Post-operative diabetic patients receiving PCI have large fluctuations in blood sugar, which may increase adverse cardiovascular events and mortality rate.