糖化血红蛋白对非糖尿病患者急性心肌梗死预后的影响

Influence of glycosylated hemoglobin on prognosis in nondiabetic patients with acute myocardial infarction

目的：评估入院糖化血红蛋白（HbAlc）水平对非糖尿病患者急性心肌梗死预后的影响。方法纳入2005年1月~2010年12月在湖北理工学院附属医院急性心肌梗死（AMI）且不合并糖尿病患者420例，所有患者在入院后即刻采血，采用比色法检测血糖（Glu）、高压液相层析法检测HbAlc。将患者根据入院HbAlc水平分为4组：3.5%≤HbAlc＜5.0%（n=122），5.0%≤HbAlc≤5.5%（n=87），5.5%≤HbAlc＜6.0%（n=109）和6.0%≤HbAlc＜6.5%（n=102）。主要研究终点为1年全因死亡率，次要终点是30天死亡率和CK-MB峰值。结果入组患者总体1年死亡率为13.57%，其中3.5%≤HbAlc＜5.0%组为8.2%，5.0%≤HbAlc＜5.5%组为11.5%，5.5%≤HbAlc＜6.0%组为13.8%，6.0%≤HbAlc＜6.5%组为21.6%，各组间均有统计学差异；但各组间30 d死亡率和CK-MB峰值无统计学差异（P＞0.05）。Cox回归模型显示HbA1c是1年死亡风险的独立预测因子（OR=1.2，P＜0.05）。结论急性心肌梗死的非糖尿病患者入院时HbA1c水平是患者1年死亡率的预测指标，HbA1c水平越高则患者1年死亡率越高。

Objective To review the influence of glycosylated hemoglobin （HbA1c） on the prognosis in nondiabetic patients with acute myocardial infarction （AMI）.Methods The AMI patients （n=420） without diabetes were chosen from Jan. 2005 to Dec. 2010. The blood samples were collected immediately after hospitalization for detecting the level of plasma glucose （Glu） by using chromatoptometry and detecting the level of HbA1c by using HPLC. All patients were divided, according to HbA1c level at being hospitalizing, into 3.5%≤HbAlc0.05）. Cox regression model showed that HbAlc was an independent predictive factor of 1-year mortality （OR=1.2, P〈0.05）.Conclusion The level of HbAlc at being hospitalizing is a predictive index for 1-year mortality in the nondiabetic patients with AMI, and 1-year mortality will increase when the level of HbAlc increases.