血糖变异性对非糖尿病急性ST段抬高型心肌梗死患者左心功能的影响

Impact of blood glucose variability on left ventricular function in non-diabetic patients with ST-elevation myocardial infarction

目的 探讨血糖变异性对非糖尿病急性ST段抬高型心肌梗死（STEMI）患者左心功能的影响。方法 选取2016年1月至2017年2月在首都医科大学附属北京安贞医院住院的非糖尿病初发急性STEMI、接受急诊经皮冠状动脉介入治疗患者184例，采用动态血糖监测系统测量日内平均血糖波动幅度（MAGE），根据MAGE水平将患者分为低MAGE组（＜2.78 mmol/L ,120例）和高MAGE组（≥2.78 mmol/L,64例）。收集并比较2组患者的一般资料、实验室检查及超声心动图检查结果，分析MAGE水平与患者左心功能的相关性。结果 高MAGE组体重指数、总胆固醇、低密度脂蛋白胆固醇明显高于低MAGE组［（27.0±2.2）kg/m2比（25.9±2.4）kg/m2、（5.1±1.4）mmol/L比（4.4±0.9）mmol/L、（3.4±1.3）mmol/L比（2.7±0.7）mmol/L］，差异均有统计学意义（均P＜0.05）。2组空腹血糖、糖化血红蛋白（HbA1c）水平、心功能Killip分级及左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）水平差异均有统计学意义（均P＜0.05）。LVEF与MAGE水平呈负相关（r=-0.23，P＜0.05）；LVEDD与体重指数、MAGE水平呈正相关（r=0.229，P＜0.05；r=0.389，P＜0.001）；心功能Killip分级与HbA1c和MAGE水平均呈正相关（rs=0.37，P＜0.05；rs=0.35，P＜0.05）。多元线性回归结果显示，MAGE水平是LVEDD的独立危险因素（P＜0.05）。多因素Logistic回归分析结果显示，HbA1c和MAGE水平是心功能Killip分级的独立危险因素（P＜0.05）。结论 血糖波动幅度较大与急性STEMI患者左心功能的恶化相关。

Objective To explore the impact of blood glucose variability on left ventricular function in non-diabetic patients with ST-elevation myocardial infarction（STEMI）. Methods Totally 184 non-diabetic patients with STEMI who had emergency percutaneous coronary intervention（PCI） from January 2016 to February 2017 in Beijing Anzhen Hospital, Capital Medical University were enrolled. All patients were monitored of mean amplitude of plasma glucose（MAGE） and they were divided into low MAGE group（＜2.78 mmol/L, n＝120） and high MAGE group（≥2.78 mmol/L, n＝64）. General information, laboratory results and echocardiographic findings were recorded. The correlation between MAGE and left ventricular function was analyzed. Results Body mass index, serum levels of total cholesterol and low-density lipoprotein cholesterol in high MAGE group were significantly higher than those in low MAGE group［（27.0±2.2）kg/m2 vs （25.9±2.4）kg/m2, （5.1±1.4）mmol/L vs （4.4±0.9）mmol/L, （3.4±1.3）mmol/L vs （2.7±0.7）mmol/L］（P＜0.05）. Fasting blood glucose, glycosylated hemoglobin（HbA1c）, Killip grade, left ventricular ejection fraction（LVEF） and left ventricular end-diastolic diameter（LVEDD） showed significant differences between groups（P＜0.05）. LVEF was negatively correlated with MAGE（r＝-0.23， P＜0.05）. LVEDD was positively correlated with body mass index and MAGE（r＝0.229， P＜0.05； r＝0.389， P＜0.001）. Killip grade was positively correlated with HbA1c and MAGE（rs＝0.37， P＜0.05； rs＝0.35， P＜0.05）. Multiple linear regression analysis showed that MAGE was an independent risk factor of LVEDD（P＜0.05）. Multivariate logistic regression analysis showed that HbA1c and MAGE were independent risk factors of Killip grade（P＜0.05）. Conclusion A large fluctuation range of blood glucose is related to deterioration of left ventricular function in patients with STEMI.