急性冠状动脉综合征患者应激性高血糖与全球急性冠状动脉事件注册评分的相关性研究

Relationship between Stress Hyperglycemia and GRACE Risk Stratification in Patients with Acute Coronary Syndrome

目的探讨急性冠状动脉综合征(ACS)患者应激性高血糖与全球急性冠状动脉事件注册(GRACE)评分及危险分层的相关性。方法入选2010年1月—2011年1月在新疆医科大学第一附属医院就诊的255例ACS患者,根据应激性高血糖的定义,将其分为ACS不合并应激性高血糖组(非应激性高血糖组,113例)和ACS合并应激性高血糖组(应激性高血糖组,142例)。入院后行常规实验室检查及超声心动图检查,采用GRACE评分标准计算患者的GRACE评分并进行危险分层,分析患者血清葡萄糖与GRACE评分及危险分层间的关系。结果应激性高血糖组与非应激性高血糖组的年龄、性别、高血压病史、吸烟、心率、收缩压、血小板计数、血钾、低密度脂蛋白、高密度脂蛋白间差异均无统计学意义(P>0.05);白细胞计数、肌酐、尿素氮、肌酸激酶同工酶、肌钙蛋白、D-二聚体、左室舒张末期内径、左室射血分数、GRACE评分间差异均有统计学意义(P<0.05)。GRACE高危组与中低危组的血糖水平比较,差异有统计学意义(P<0.05)。应激性高血糖组中GRACE评分与血糖水平呈正相关(r=0.287,P<0.001);非应激性高血糖组中GRACE评分与血糖水平呈正相关(r=0.451,P<0.001)。血糖水平、左室舒张末期内径、左室射血分数、肌钙蛋白对GRACE评分的影响有统计学意义(P<0.05)。结论 ACS患者应激性高血糖与GRACE评分及其危险分层有相关性。

Objective To study the relationship between stress hyperglycemia（ SH） and GRACE risk stratification in patients with acute coronary syndrome（ ACS）. Methods We enrolled 255 patients with ACS who were admitted in the First Affiliated Hospital of Xinjiang Medical University during January 2010 to January 2011. The patients were divided into non-SH ACS group（ 113 cases） and SH ACS group（ 142 cases） according to the definition of SH. All the patients received routine laboratory tests and echocardiography examination. The GRACE risk score were calculated for risk stratification. The relationship between patients＇ serum glucose and GRACE risk stratification was analyzed. Results SH group and non-SH groups were not statistically different in age,gender,hypertension history,smoking,heart rate,systolic pressure,blood platelet count,serum potassium,LDL and HDL（ P〉0. 05）. There were different between the 2 groups in WBC,Cr,BUN,CK-MB,troponin,D-dimer,LVEDD,LVEF,and GRACE score（ P〈0. 05）. Serum glucose in the high risk GRACE group was different comparing with the moderate and low risk GRACE group（ P〈0. 05）. GRACE score and serum glucose were positively correlated in the SH group（ r = 0. 287,P〈0. 001）; GRACE score and serum glucose were also positively correlated（ r = 0. 451,P〈0. 001） in the non-SH groups. GRACE score was influenced by serum glucose,LVEDD,LVEF,troponin（ P〈0. 05）. Conclusion Stress hyperglycemia is correlated with GRACE risk stratification score in patients with ACS.