非糖尿病急性心肌梗死合并与不合并应激性高血糖患者的对比观察

The predictive value of NT- pro BNP to the disease severity and early prognosis in the patients with non- diabetic acute myocardial infarction combining stress hyperglycemia

目的探讨非糖尿病急性心肌梗死合并应激性高血糖患者与非糖尿病急性心肌梗死未合并应激性高血糖患者的心功能指标、氨基末端B型利钠肽原(NT-pro BNP)水平及其他心血管事件发生率。方法选取2013年9月至2014年9月期间收治的124例非糖尿病急性心肌梗死合并应激性高血糖的患者作为研究组,另选取124例同期收治的非糖尿病急性心肌梗死未合并应激性高血糖的患者作为对照组,记录两组患者入院24 h内的实验室检查结果、记录入院一周内的动态心电图和超声心动图以及入院2周内两组患者中心力衰竭、心源性休克和心律失常等的发生率,并进行对比分析。结果研究组患者入院24 h内的肌酸激酶MB同工酶(CK-MB)、肌红蛋白(MYO)、超敏肌钙蛋白I(ultra-Tn I)和NT-pro BNP水平均明显高于对照组,差异有统计学意义(P<0.05);研究组患者入院2周内心力衰竭、心源性休克和心律失常的发生率均明显高于对照组,差异有统计学意义(P<0.05);心功能参数的比较研究组患者左心室射血分数(LVEF)显著低于对照组,而左心室舒张末期内径(LVDd)和左心室收缩期末期内径(LVDs)则显著高于对照组,差异均有统计学意义(P均<0.05)。结论非糖尿病急性心肌梗死患者合并应激性高血糖时,较不合并应激性高血糖患者心功能受损更严重,预后可能更差。

Objective To explore the cardiac function indexes,NT- pro BNP level and the occurrence rate of other cardiovascular events in patients with non- diabetic AMI incorporating and unincorporating stress hyperglycemia. Methods 124 patients with non- diabetic AMI incorporating stress hyperglycemia were chosen as the research group in our hospital from September 2013 to September 2014,another 124 cases with non- diabetic AMI unincorporating stress hyperglycemia were chosen as the control group,the laboratory results within 24 hours of onsets,dynamic electrocardiogram and echocardiography within one week of onsets and the incidence rate of heart failure,cardiac shock and arrhythmia within two weeks of onsets of the two groups were compared and analyzed. Results The levels of NT- pro BNP,CK- MB,MYO and ultra- Tn I of the research group patients within 24 hours of onsets were higher than the control group,the differences were statistically significant（ all P〈0. 05）. The incidence rates of heart failure,cardiac shock and arrhythmia of the research group patients were higher than the control group,the differences were statistically significant（ all P〈0. 05）. The LVEF of the research group patients was lower,but the LVDd and LVDs were higher than the control group,the differences were statistically significant（ all P〈0. 05）. Conclusion The cardiac function will be worse when the patients with non-diabetic AMI incorporating stress hyperglycemia,and the prognosis will also be worse.