非ST段抬高心肌梗死患者初发高血糖的探讨

Clinical Study of hyperglycemia in patients with non-ST-elevation myocardial infarction

目的:观察非ST段抬高心肌梗死(NSTEMI)患者发病初期血糖的变化,以了解此类患者血糖的变化规律。方法:对2010年3月～2011年6月在我院住院的既往无糖尿病史并发NSTEMI的86例患者作为研究对象。入院即刻及入院后第2～7天清晨6点采集患者空腹血液,进行空腹血糖浓度测定,并在第7天行OGTT。结果:86例患者中,新诊断为糖尿病者28人,糖调节受损者39人,糖代谢正常者19人。糖代谢正常者平均血糖在入院后第2天降至正常水平。空腹高血糖与OGTT阳性一致性检验Kappa=0.260,P=0.014,在校正其它变量的情况下,第2天空腹血糖≥7.0mmol/L都是糖尿病(OGTT阳性)的预测因素(风险比=3.55,95%可信区间2.114～11.126,P=0.012。结论:既往无糖尿病史的NSTEMI患者大多合并有糖调节受损或糖尿病(67人,77.9%),需及时进行OGTT,以明确糖尿病或糖调节受损。糖代谢正常者一般血糖在入院后第2天降至正常水平。持续高血糖是糖调节受损或糖尿病的预测因子。

Objective： To discover the regulation of blood glucose changes by observing the hyperglycemia in patients at the early stage of non-ST-elevation myocardial infarction （NSTEMI）. Methods： 86 NSTEMI patients without previous history of DM admitted in Panyu Central Hospital between March 2010 and June 2011 were analyzed. Blood glucose was measured at baseline and the fasting glucose was examined on the 2nd to 7th day after admission. On the 7th day, OGTT was conducted. Results： Among the 86 patients, 28 patients were newly diagnosed DM, 39 were impaired glucose regulation, and 19 were normal glucose metabolism. The average blood glucose was down to normal level on the 2nd day for the normal glucose metabolism group. The accordance between fasting hyperglycemia and positive OGTT was as Kappa = 0. 260,P= 0. 014.With the adjusted variations,the fasting glucose ≥ 7. 0mmol/L on the 2nd day of admission were the predictors for DM,and OR= 3. 55,95% CI 2. 114 ～ 11. 126,P= 0. 012. Conclusion： Most NSTEMI patients, as high as 77.9% , without previous history of DM may combine with impaired glucose regulation or DM. Therefore, for guiding of clinic treatment, OGTT should be performed to clarify it should be impaired glucose regulation, DM or not.In conclusion, persistent fasting hyperglycemia could be regarded as a predictive risk factor in patients with impaired glucose regulation or DM.