应激性高血糖对非糖尿病急性ST段抬高心肌梗死患者肾功能及临床预后的影响

Impact of admission hyperglycemia on in- hospital renal function and prognosis in nondiabetic patients with ST- segment elevation myocardial infarction

目的探讨入院应激性高血糖对非糖尿病急性ST段抬高心肌梗死(STEMI)患者肾功能及临床预后的影响。方法选择760例非糖尿病急性STEMI患者,均行冠脉介入术。以入院时血肌酐≥26.4μmol/L或入院48 h内增加50%作为急性肾损伤(AKI)的诊断依据分为AKI组和非AKI组。比较2组患者年龄、性别、体质量指数、高血压、高血脂、吸烟、入院前用药情况及入院时血糖、肌酐及其他基线生化参数。统计2组患者住院时间及住院期间主要心血管不良事件(MACE)、住院病死率,同时应用生活质量评价量表SF-36评价患者出院时生活质量。Logistic回归分析入院应激性高血糖与AKI发生的相关性及对预后的影响。结果 AKI组96例(13%),入院血糖水平、MACE发生率及住院病死率均明显高于非AKI组(P均<0.05),住院时间明显长于非AKI组(P<0.05),且AKI发生率随入院血糖水平的升高而增加。AKI组SF-36量表中的身体机能、躯体角色、活力、角色情绪、总体健康评分均明显低于非AKI组(P均<0.05)。多因素分析显示入院应激性高血糖可作为AKI发生的独立预测因子[OR=1.10,95%CI(1.03,1.18),P=0.02]。结论入院应激性高血糖可导致急性STEMI患者AKI的发生,增加MACE发生率及住院病死率,并降低患者的生活质量。

Objective It is to investigate how admission hyperglycemia affects in-hospital renal function and prognosis in nondiabetic patients with ST- segment elevation myocardial infarction（ STEMI）. Methods We retrospectively analyzed 760 consecutive elderly patients with STEMI. Blood sample was obtained on admission and repeated sampling was done at least every 1 or 2 days during the first week. Acute kidney injury（ AKI） was diagnosed as increase in serum creatinine ≥26. 4 μmol /L or ≥50% within any 48 h. These patients were compared with respect to baseline characteristics,all-cause mortality and major adverse cardiovascular events（ MACE）. The postoperative QOL were evaluated by Short- Form life survey- 36 items（ SF- 36）. Results Ninety-six patients（ 13%） had AKI during hospitalization for AMI,and these patients had higher in-hospital mortality and MACE than those without AKI（ P〈0. 05）. Patients with AKI extended hospital days（ P〈0. 05）. Patients with AKI had higher plasma glucose（ PG） on admission than those without. The incidence of AKI increased as admission PG rose. On multivariate analysis admission PG was an independent predictor of AKI [OR = 1. 10,95% CI（ 1. 03,1. 18）,P =0. 02） ]. The physical function,role physical,general health,vitality,role emotional dimensions were significantly decreased in patients with AKI（ P〈0. 05）. Conclusion Admission hyperglycemia might have contributed to the development of AKI in patients with STEMI. These patients experienced a significantly higher incidence of all-cause mortality and MACE,with decreased quality of life.