空腹血糖水平对ST段抬高型急性心肌梗死患者发生院内心血管事件的影响

Impact of fasting flood glucose levels on adverse cardiovascular event of ST-segment elevation myocardial infarction patients

目的探讨有糖尿病和无糖尿病的sT段抬高型急性心肌梗死（STEMI）患者入院后48小时内平均空腹血糖水平与院内心血管事件发生的相关性。方法将350例STEMI患者按入院48小时平均空腹血糖水平分为〈5．6mmol／L、5．6～7．0mmol／L、7．0～10．0mmol／L、〉10．0mmol／L4组。比较4组患者临床资料，分析有无糖尿病的STEMI患者院内主要心血管事件的发生情况，以多因素Logistic回归分析确定急性心肌梗死（AMI）患者院内心血管事件的危险因素。结果（1）高血糖患者中有相当比例患者既往无糖尿病史；各血糖水平组内，无糖尿病的患者使用胰岛素的比例明显低于有糖尿病的患者（P〈0．05）。（2）无糖尿病的STEMI患者随着平均空腹血糖的升高，心血管事件发生率呈逐渐上升的趋势（P〈0．05），而有糖尿病的患者院内心血管事件的发生率呈先降低后升高的变化。（3）多因素Logistic回归分析显示，平均空腹血糖是院内心血管事件的独立危险因素（OR=1．105，95％CI：1．028～1．415，P〈0．05），而糖尿病并不是院内心血管事件的独立危险因素（OR：1．351，95％CI：0．667—1．566，P〉0．05）。结论平均空腹血糖水平是STEMI患者发生院内心血管事件的独立危险因素，而糖尿病病史不是其独立危险因素。

Objective To explore the correlations between the average fasting plasma glucose （FPG） level within 48 hours after admission and occurrence of nosocomial adverse cardiovascular events （ACE） for ST-segment elevation acute myocardial infarction （STEMI） patients with or without known diabetes. Methods Total enrolled 350 STEMI patients were divided into four groups by their average FPG value within 48h after admission, 〈5.6 mmoL/L,5.6-7.0 mmoL/L,7.0-10.0 mmol/L,and 〉 10.0 mmol/L. Multivariate Logistic regression analysis was used to define the risk factors of nosocomial ACE for AMI patients by comparing the clinical characteristics of four groups and analyzing specific circumstances of major ACE of STEMI patients with or without known diabetes. Results （ 1 ） Considerable proportion of hospitalized hyperglycemia patients had no previous diabetic history;insulin usage ratio for non-diabetic patients was found significantly lower than those diabetic patients （ P 〈 0.05 ） in each contrast group. （2） For the non-diabetic STEMI patients, ACE occurrence escalated with elevation of average FPG level （P 〈 0.05 ） ; while for diabetic patients, incidence of ACE rose up after initial decline. （3） The multivariate Logistic regression analysis indicated that average FPG level was an independent risk factor for nosocomial ACE （ OR = 1. 105,95% CI： 1. 028-1. 415 ,P 〈 0.05） ,while diabetes is not such independent risk factor （ OR = 1.351,95 % CI： 0. 667-1. 566, P 〉 0.05 ）. Conclusions Elevated average FPG level is an inde- pendent risk factor of ACE by STEMI patients,while diabetic history is not such independent risk factor.