老年急性心肌梗死患者应激血糖和血清胱抑素C及肾小球滤过率与近期预后的关系

Relationship of stress hyperglycemia, cystatin C and glomerular filtration rate with short-term prognosis in elderly patients with acute myocardial infarction

目的探讨老年急性心肌梗死（AMI）患者应激血糖、血清胱抑素C（CysC）、估测肾小球滤过率（eGFR）水平及与近期预后的关系。方法序贯人选AMI患者242例，根据年龄分为老年组182例，非老年组60例，收集CysC、eGFR、应激血糖等临床资料，观察住院期间及出院后30d主要不良心血管事件（MACE）发生情况。结果老年组患者应激血糖升高发生率、肌酐、CysC、脑钠肽及总MACE发生率较非老年组高（P〈0．05），eGFR偏低（P〈0．05）。老年组CysC与年龄、体质指数、肌酐、脑钠肽呈正相关（P〈0．05），与空腹血糖、eGFR负相关（P％0．05）。老年组eGFR与体质指数呈正相关（P〈0．05），与年龄、肌酐、脑钠肽负相关（P〈0．05）。Logistic回归分析结果显示，应激血糖升高（OR=1．871，95％CI：1．071～3．269，P=0．03）、CysC（OR=7．093，95％CI：2．261～22．249，P=0．00）是发生MACE危险因素。结论CysC、eGFR可用于反映老年AMI患者早期肾功能不全及判断预后。老年应激血糖升高发生率高，应激血糖、CysC为MACE发生独立危险因素。

Objective To investigate the relationship of stress hyperglycemia, cystatin C and estimated glomerular filtration rate （eGFR） with short-term prognosis in elderly patients with acute myocardial infarction. Methods 242 consecutive patients with acute myocardial infarction were divided into two groups according to age： the elderly group （n= 182）, and the non-elderly group （n= 60）. The clinical data including cystatin C （Cys C）, eGFR and stress hyperglycemia levels were collected. The major adverse cardiovascular events （MACE） were observed during hospitalization and 30 days after discharge. Results The incidences of stress hyperglycemia, the levels of creatinine, Cys C and brain natriuretic peptide （BNP）, as well as the total MACE were higher and eGFR was lower in elderly group than in non-elderly group （all P〈0.05）. Cys C level was positively correlated with age, body mass index and levels of creatinine and BNP （all P〈0.05）, and negatively correlated with fasting glucose and eGFR in elderly group （both P〈0.05）. The eGFR was positively correlated with body mass index （P〈0.05）, and negatively correlated with age, creatinine and BNP levels in elderly group （all P〈0.05）. Logistic regression analysis indicated that stress hyperglycemia [OR= 1.871, 95%CI： 1.071-3.269, P=0.03], Cys C [OR=7.093, 95% CI： 2.261-22.249, P=0.00] were the independent risk factors for MACE. Conclusions Cys C level and eGFR can predict the early renal dysfunction and its prognosis in elderly patients with acute myocardial infarction. The incidence of stress hyperglycemia is higher in the elderly, and stress hyperglycemia and Cys C level are the independent risk factors for MACE.