经皮冠状动脉介入术、高血糖对非ST段抬高型心肌梗死患者预后的影响研究

Impact of PCI and Hyperglycemia on Prognosis of Patients with Non ST-segment Elevation Myocardial Infarction

目的 探讨经皮冠状动脉介入术、高血糖对非ST段抬高型心肌梗死患者预后的影响。方法 选取2013年1月—2014年8月巨野县人民医院心内二科收治的非ST段抬高型心肌梗死患者218例,依据发病后血糖高低及是否行介入治疗分为高血糖介入组（A组,n=50）、高血糖非介入组（B组,n=53）、正常血糖介入组（C组,n=57）、正常血糖非介入组（D组,n=58）。记录4组患者性别、年龄、收缩压、吸烟史、高血压病史、冠心病家族史、心率、Killip分级、发病至入院时间等一般资料及肌钙蛋白I峰值、高密度脂蛋白、低密度脂蛋白、血肌酐等实验室检查指标,并比较4组患者心脏不良事件发生情况。结果 4组患者性别、年龄、收缩压、吸烟史阳性率、高血压病史阳性率、冠心病家族史阳性率,心率、Killip分级〉Ⅰ级者所占比例、发病至入院时间、肌钙蛋白I峰值、高密度脂蛋白、低密度脂蛋白及血肌酐比较,差异无统计学意义（P〉0.05）。4组患者随访12个月时心脏不良事件发生率比较,差异有统计学意义（P〈0.05）。绘制Kaplan-Meier生存曲线发现,A组患者累积心脏不良事件发生率低于B组,C组患者累积心脏不良事件发生率低于D组（P〈0.05）,而A组与C组患者、B组与D组患者累积心脏不良事件发生率比较,差异无统计学意义（P〉0.05）。出院9个月后,B组患者累积心脏不良事件发生率有所增加,延长随访时间至第12-18个月时,B组患者累积心脏不良事件发生率高于D组（P〈0.05）。结论 无论是否合并高血糖,经皮冠状动脉介入术均是改善非ST段抬高型心肌梗死患者预后的最佳治疗方案,而高血糖是影响患者预后的重要因素之一。

Objective To investigate the impact of PCI and hyperglycemia on prognosis of patients with non ST-segment elevation myocardial infarction. Methods From January 2013 to August 2014, a total of 218 patients with non ST-segment elevation myocardial infarction were selected in the Second Department of Cardiology, the People＇s Hospital of Juye County, and they were divided into A group （ with hyperglycemia and received PCI, n = 50）, B group （ with hyperglycemia but did not receive PCI, n = 53）, C group （with normal blood glucose and received PCI, n = 57） and D group （ with normal blood glucose but did not receive PCI） according to the blood glucose after attack and whether received PCI or not. General information （including gender, age, SBP, smoking history, history of hypertension, family history of coronary heart disease, heart rate, Killip grade, duration between attack and admission） and laboratory examination results （ including peak value of troponin Ⅰ, HDL, LDL and Scr） of the four groups were recorded, and incidence of cardiac adverse events was compared among the four groups. Results No statistically significant differences of gender, age, SBP, positive rate of smoking history or hypertension history, positive rate of family history of coronary heart disease, heart rate, proportion of patients with Killip grade over Ⅰ grade, duration between attack and admission, peak value of troponin Ⅰ, HDL, LDL or Scr was found among the four groups （ P 〉 0. 05 ）. There was statistically significant differences of incidence of cardiac adverse events among the four groups till the 12 - month follow - up. Kaplan - Meier survival curve showed that, cumulative incidence of cardiac adverse events of A group was statistically significantly lower than that of B group, meanwhile cumulative incidence of cardiac adverse events of C group was statistically significantly lower than that of D group （P 〈 0. 05 ）, but no statistically significant differences of cumulative incidence of Cardiac adverse events was found between A group and C group, nor was cumulative incidence of cardiac adverse events between B group and D group （P 〉 0. 05）. After 9 months of discharge, the cumulative incidence of cardiac adverse events of B group was slightly increased, during the prolonged 12 to 18 months of follow - up, the cumulative incidence of cardiac adverse events of B group was statistically significantly higher than that of D group （ P 〈 0. 05 ）. Conclusion Whether complicated with hyperglycemia or not, PCI is the optimal therapeutic schedule for non ST-segment elevation myocardial infarction, hyperglycemia is an important factor that influencing the prognosis.