入院高血糖与急性心力衰竭患者近期预后的关系

The association of admission hyperglycemia with outcome of patients with acute heart failure

目的：探讨入院高血糖与急性心力衰竭患者近期预后的关系。方法150例急性心力衰竭患者入院次日清晨采集血样，测定血糖、胰岛素、肝肾功能、N末端B型脑钠肽原，采用多元Logistic回归分析及ROC曲线对与急性心力衰竭患者病情严重程度及30d内全因死亡的可能相关因素进行分析。结果（1）患者按入院血糖分为四组（Q1~4），Q3、Q4组住院天数明显高于Q1、Q2组（P＜0.05）；各组30d全因死亡率呈上升趋势，组内比较差异有统计学意义（P＜0.05）。（2）入院高血糖是30d 全因死亡的独立预测因素。血糖每升高1mmol / L，患者死亡风险增加1.26倍[OR （95% CI）：1.352（1.061~1.511），P＜0.01]。（3）血糖为8 mmol/L时，预测30d全因死亡的敏感度80%，特异度51%；血糖10mmol/L时，敏感度52%，特异度81%。结论急性心力衰竭患者入院高血糖不仅是反映病情严重程度的指标，还与近期预后不良有关。

Objective To determine the association of admission hyperglycemia with short- term outcome of patients with acute heart failure （AHF）. Methods Blood samples were col ected at the second day morning after admission for measuring blood glucose, insulin, hepatic and renal function, NT- pro brain natriuretic peptide （NT- Pro BNP） in 150 AHF patients. Multivariate Logistic regression analysis and receiver operating characteristic （ROC） curve were performed for analyzing relative factors with the severity of AHF and al- cause mortality within 30 days. Results （1）Patients were divided into Q1~Q4 group by quartile of admission blood glucose. Length of stay was significantly longer in Q3 and Q4 groups than Q1 and Q2 groups（P〈0.05）. 30- day al- cause mortality increased from Q1to Q4 with significant difference between groups （P〈0.05）. （2） The admission hyperglycemia was an independent predictor of 30- day mortality in AHF. The risk of mortality increased by 1.26- fold for every 1 mmol/L increase in blood glucose [OR （95%CI） 1.352 （1.061~1.511）, P〈0.01]. （3） The sensitivity and specificity for predicting al- cause 30- day mortality were 80%and 51%, respectively, when serum glucose was 8 mmol/L, 52%and 81%when serum glucose was 10 mmol/L. Conclusion Admission hyperglycemia is a marker of the severity of il ness and related to the worse short- term prognosis.