空腹血糖对非糖尿病患者急性心肌梗死预后的相关性研究

Influence of fast blood glucose on the prognosis of patients with non-diabetic acute myocardial infarction

目的：研究入院空腹血糖与非糖尿病患者急性心肌梗死远期预后的相关性。方法：收集2005—2010年在广东省人民医院确诊的急性心肌梗死患者564例，入院后监测空腹血糖并予分组：A组，〈6．1mmol／L（152例）；B组，6．1．7．0mmol／L（124例）；C组，7．O～11．1mmol／L（240例）；D组，〉11．1mmol／L（48例）。分析各组36个月后的心源性死亡率及不良事件。结果：D组心源性休克史较其他组明显偏高（P=O．004）：左室收缩功能（LVEF）较其他组偏低（P=O．018）；而肌酐、尿素氮均较其他组明显升高（P值分别为：0．018、0．038）。多变量Logistic回归分析提示，D组较正常血糖组死亡率明显增多，且伽为4．476（P〈0．001）。次要研究终点结果提示非糖尿病患者急性心肌梗死时，空腹血糖水平与反复心衰发作明显相关（P〈O．001）。Kaplan—Meier法分析发现：D组平均生存时间明显低于其他3组（P〈0．001）。结论：非糖尿病患者发生急性心肌梗死时，空腹血糖水平越高，提示远期预后越差，且与反复发作心衰明显相关。

Objective To evaluate the usefulness of fast blood glucose level on monitoring the out-come of non-diabetic acute myocardial infarction （AMI） patients. Methods A total of 564 AMI patients screened from 2005 and 2010 in department of cardiology, Guangdong general hospital were included in this study. The patients were divided into four groups by the level of fast blood glucose： group A （n = 152）, blood glucose level, 〈 6.1 retool/L; group B （n = 124）： 6.1 -7.0mmol/L; group C （n = 240）： 7.0 - 11.1 mmol/L; group D （n = 48）： 〉11.1 mmol/ L. Clinical data, adverse events and mortality were analysised with following up for 36 months. Results In group D, the percentage of the patients who had history of cardiac shock was higher than other groups （P = 0.004） and the LVEF was lower than the other groups （P = 0.018）. Wherea, the Cr and BUN in group D were significantly higher than in other groups （P = 0.018 and P = 0.038, respectively）. The mortality of group D was significantly higher then that of normal blood glucose group and the odds ratios was 4.476 （P 〈 0.001）. The secondary endpoints showed that admission blood glucose level was significantly associated with the recurrent heart failure （P 〈 0.001）. The average survival time of group D was substantionally lower than other three groups （P 〈 0.001 ）. Conclusion The level of fast blood glucose is significantly associated with mortality in non-diabetic AMI patients and is significantly associated with the recurrent heart failure.