空腹血糖与急性心肌梗死患者冠脉病变程度及近期预后的关系

Relationship between fasting plasma glucose and extent of coronary artery lesion in patients with acute myocardial infarction

目的探讨空腹血糖(FPG)对急性心肌梗死(AMI)患者近期预后的预测价值及其与心功能、冠脉严重程度的相关性。方法根据患者入院次日静脉FPG水平,将235例AMI患者分为2组:FPG正常组(n=72):FPG<6.1mmol/L;FPG升高组(n=163):FPG≥6.1mmol/L;比较2组入院时killips分级、1周左室射血分数(LVEF)、冠脉严重程度(Gensini积分)、住院30d病死率。结果 (1)基线情况无差异的2组入院时killip分级、1周LVEF无显著差异,FPG升高组Gensini积分显著高于FPG正常组;(2)相关分析显示FPG与LVEF呈负相关,与Gensini积分呈正相关;(3)logistic回归分析显示FPG升高对于总体住院30d病死率及溶栓治疗住院30d病死率均有显著预测价值。结论 FPG升高为院内充血性心力衰竭和死亡的独立预测因子,且可反映冠脉病变严重程度。

Objective Stress hyperglycemia in patients with acute myocardial infarction（AMI） has been associated with increased risk of death.Limited information is available about the association of fasting plasma glucose（FPG） with hospitalization death,heart function and extent of coronary artery lesion.Methods The relationship of FPG with 30-day mortality,left ventricular ejection fraction（LVEF） and Gensini score in 235 patients with AMI were investigated by using correlation analysis and logistic regression.FPG was measured in each patient within 24 hours of admission.According to FPG level,all patients were divided in two groups：normal group（FPG6.1 mmol/L） and high FPG group（FPG≥6.1 mmol/L）.Results The proportion of LVEF≥45% and the Gensini scores were not significantly different between normal and high FPG groups.In the correlation analysis,FPG was negatively correlated with LVEF and positively correlated with Gensini score.In logistic analysis,FPG≥6.1 mmol/L was associated with increased risk of 30-day death in the patients with AMI,especially for the patients who underwent thrombolytic therapy.Conclusions Elevated FPG can be considered as an independent predictor of congestive heart failure and hospitalization death in patients with AMI.FPG is associated with severity of coronary artery lesion.