心肌梗死与脑梗死患者急性期发生高血糖的危险因素分析

Analysis of risk factors for occurring hyperglycemia in patients with acute myocardial infarction and cerebral infarction

目的分析急性心肌梗死与急性脑梗死患者应激性高血糖的发生率及其影响因素。方法回顾性分析2009年1月—2012年12月首都医科大学宣武医院心脏科连续收治的1630例初发心肌梗死不伴脑血管疾病及神经内科连续收治的1338例初发动脉粥样硬化型急性脑梗死不伴心血管疾病患者的病例资料，从中筛选出无糖尿病患者2048例，其中心肌梗死组1165例，脑梗死组883例。将人院次日清晨空腹静脉血糖〉7．8mmol／L定义为高血糖，采用单因素分析和多因素Logistic分析两组应激性高血糖的发生率及其影响因素。结果（1）心肌梗死患者1165例中，应激性高血糖的发生率为17．2％（201例）；脑梗死患者883例中，应激性高血糖的发生率为为5．4％（48例），两组比较差异有统计学意义（x^2=65．677，P〈0．01）。（2）心脑血管疾病应激性高血糖（249例）与非应激性高血糖（1799例）患者一般资料对比分析显示，两组高脂血症、饮酒史、有心脑血管病家族史、年龄、心率、总胆固醇、低密度脂蛋白胆固醇、血中白细胞计数、尿素氮、三酰甘油差异有统计学意义（P〈0．05）。（3）多因素Logistic分析显示，心率（OR=1．013，95％CI：1．002—1．024）、血中白细胞计数（OR=1．109，95％CI：1．508～1．163）、三酰甘油（OR=1．174，95％CI：1．042～1．322）是心肌梗死应激性高血糖的独立危险因素。（4）多因素Logistic回归分析显示收缩压（OR=1．019，95％CI：1．006—1．033）及血中白细胞计数（OR=1．132，95％CI：1．009—1．268）是脑梗死应激性高血糖的独立危险因素。结论急性心肌梗死患者应激性高血糖的发生率高于急性脑梗死，血中白细胞计数升高是两者共同的独立危险因素。

Objective To analyze the incidence of stress hyperglycemia and its influential factors in patients with acute myocardial infarction and cerebral infarction. Methods The case data of 1630 consecutive patients with incipient myocardial infarction without cerebrovascular disease admitted in the department of cardiology and 1338 patients with atherosclerotic acute cerebral infarction without cardiovascular disease admitted in the department of neurology, Xuanwu Hospital, Capital Medical University from January 2009 to December 2012 were analyzed retrospectively. A total of 2048 patients without diabetes mellitus were selected from them,among them 1165 patients were in an acute myocardial infarction group and 883 were in a cerebral infarction group. The fasting blood glucose 〉 7.8 mmol/L in the next morning after admission was defined as hyperglycemia. Single factor and multifactor logistic regression analyses were used to compare the incidence of stress hyperglycemia and its influential factors of both groups. Results （ 1 ） Of the 1165 patients with myocardial infarction, the incidence of stress hyperglycemia was 17.2% （ n = 201 ） ; of the 883 patients with cerebral infarction ,the incidence of stress hyperglycemia was 5.4% （n =48）. There was significant difference between the 2 group （X^2 = 65. 677 ; P 〈 0. 01 ）. （2） Comparing the general information of the patients with stress hyperglycemia （n =249） and those without stress hyperglycemia （ n = 1799 ） of the eardio-eerebrovascular diseases showed that there were significant differences in hyperlipidemia, drinking history, family history of eardio-eerebrovaseular diseases, age, heart rate, total cholesterol, low density lipoprotein cholesterol, leukocyte count, blood urea nitrogen, and triacylglyeerols between the 2 groups （P 〈 0.05）. （3） Multivariate Logistic analysis showed that heart rate （ OR, 1.013,95 % CI 1. 002 -1. 024 ）, leukocyte count （ OR, 1. 109,95% CI 1. 508 - 1. 163 ）, and triacylglyeerols （ OR, 1. 174, 95 % CI 1. 042 -1. 322 ） were the independent risk factors for stress hyperglycemia in myocardial infarction. （4） Systolic blood pressure （ OR, 1. 019,95% CI 1. 006 -1. 033 ） and leukocyte count （ OR, 1.132,95% CI 1.009-1. 268） were the independent risk factors for stress hyperglycemia in cerebral infarction. Conclusion The incidence of stress hyperglycemia in patients with myocardial infarction is higher than that in patients with cerebral infarction, and the increased leukocyte count is a common independent risk factor for both.