急性心肌梗死患者空腹高血糖对近期心血管事件的预测价值

Prediction of cardiovascular events in acute myocardial infarction patients through elevated fasting blood glucose

目的探讨空腹高血糖对急性心肌梗死(AMI)患者近期心血管事件的预测价值。方法入选2010年2月至2013年2月我院诊治的AMI患者183例,根据入院时空腹血糖(FBG)水平分为FBG正常组(90例)与FBG升高组(93例),FBG正常组FBG<6.0 mmol/L,FBG升高组FBG≥6.0 mmol/L。记录两组患者一般临床资料及近期主要不良心血管事件(MACE)发生情况。采用多因素Logistic回归法分析FBS是否为影响AMI近期MACE发生的因素,Kaplan-Meier生存曲线分析FBG水平与近期预后的关系。结果入院时除FBG外,患者其他临床基线资料差异无统计学意义(P>0.05);住院及18个月随访期间FBG升高组MACE发生率明显高于FBG正常组(P<0.05);多因素Logistic回归分析表明FBG升高是AMI患者近期发生新发或再发心肌梗死(OR=1.121,P=0.003)、心肌梗死后心绞痛(OR=1.094,P=0.036)、充血性心力衰竭(OR=1.066,P=0.011)、严重心律失常(OR=1.081,P=0.023)、心源性休克(OR=1.103,P=0.037)、心源性死亡(OR=1.077,P=0.026)的独立危险因子;Kaplan-Meier生存曲线分析显示,AMI患者近期MACE发生率随FBG水平升高而明显增加,FBG水平越高近期预后越差(P=0.001)。结论空腹高血糖是AMI患者近期MACE的独立预测因素,近期心血管事件发生率随着FBG水平升高而显著增加。

Objective To investigate the predictive value of cardiovascular events in patients with acute myocardial infarction （AMI）by elevated fasting blood glucose （FBG）. Methods According to FBG levels, 183 AMI patients, who were admitted to our hospital from February 2010 to February 2013, were divided into two groups. Ninety patients with FBG levels less than 6.0 mmol/L were as FBG control group, and ninety three patients with FBG levels more than or equal to 6.0 mmol/L were as high FBG group. The clinical data and major adverse cardiovascular event （MACE）, including new or recurrent AMI, post infarction angina pectoris, congestive heart failure, malignant arrhythmia, cardiac shock and cardiac death, were collected. Multinomial Logistic regression analysis was performed to determine whether FBG was an independently effective factor against short-term MACE of AMI patients. The Kaplan-Meier survival curve was used to analyze the relationship between FBG and short-term prognosis. Results The general clinical baseline in two groups were similar （P^0.05） except FBG levels. During hospital and after followed up for 18 months, the rate of MACE in high FBG group was higher than the FBG control group （P〈0.05）. Multinomial Logistic regression analysis showed that elevated FGB was independent hazard factor against AMI, including new or recurrent AMI （OR=1. 121, P=-0.003）, post infarction angina pectoris （OR=1.094, P=0.036）, congestive heart failure （OR=1.066, P=0.011 ）, malignant arrhythmia （OR=1.081,P=0.023）, cardiac shock （OR=l.103, P=0.037） and cardiac death （OR=1.077, P=0.026）. Kaplan-Meier survival curve suggested that the rate of short-term MACE in AMI patients was obviously increased with elevated FBG levels （P=-0.001）. Conclusion Elevated FBG is an independent predictive factor for short-term MACE of AMI patients. The incidence of short- term cardiovascular events is significantly increased with the raised FBG levels.