入院高血糖对不同血糖状态非ST段抬高型心肌梗死行PCI术患者短期预后的影响

Influence of admission hyperglycemia on short-time diagnosis in patients with non-ST-segment elevation myocardial infarction undergone PCI in different blood sugar states

目的探讨在不同糖尿病状态下入院高血糖对非ST段抬高型心肌梗死(NSTEMI)行经皮冠状动脉造影(PCI)患者近期预后的影响,并分析入院血糖对不良预后的预测界值。方法以2009年1月至2012年10月确诊为NSTEMI并行PCI术的住院患者为研究对象。根据有无糖尿病将患者分为糖尿病及非糖尿病者,再根据入院血糖浓度将非糖尿病者分为入院血糖<144 mg/dl或≥144 mg/dl两组,糖尿病患者分为入院血糖<180 mg/dl或≥180 mg/dl两组。分别比较各组30 d主要不良心血管事件发生率,用多变量Cox回归分析主要负性心血管事件的危险因素,计算OR值及95%可信区间,ROC曲线分析预测界值。结果在非糖尿病患者中,与入院血糖<144 mg/dl组比,入院血糖≥144 mg/dl组有较高的30 d主要不良心血管事件发生率,且具有统计学差异(P<0.05)。在糖尿病患者中,与入院血糖<180 mg/dl组比,入院血糖≥180 mg/dl组,有较高的30 d主要不良心血管事件发生率,且有统计学差异(P<0.05)。4组患者比较,入院血糖<144 mg/dl组非糖尿病患者有最低的30 d主要不良心血管事件发生率,而入院血糖≥180 mg/dl组糖尿病患者有最高的30 d主要不良心血管事件发生率,均具有统计学差异(P<0.05)。入院高血糖对NSTEMI行PCI全部患者主要不良心血管事件的预测界值为157 mg/dl,非糖尿病患者为145 mg/dl,糖尿病患者为178 mg/dl。结论无论患者有无糖尿病,入院血糖水平均可作为NSTEMI行PCI患者短期主要不良心血管事件的独立预测指标。不同糖尿病状态,入院高血糖对NSTEMI行PCI患者主要不良心血管事件有不同的预测界值。

Objective To investigate the influence of admission hyperglycemia in different blood sugar states on short-time diagnosis in patients with non-ST-segment elevation myocardial infarction(NSTEMI)undergone PCI,and analyze the predictive cut-off level of admission hyperglycemia to poor prognosis.Methods NSTEMI inpatients undergone PCI were chosen from Jan.2009 to Oct.2012.All patients were divided into diabetes group and nondiabetes group.The non-diabetes group was divided,according to level of admission blood sugar(ABS),into ABS<144 mg/dl group(group 1),ABS≥144 mg/dl group(group 2),and diabetes group was divided into ABS<180 mg/dl group(group 3)and ABS≥180 mg/dl group(group 4).The incidence rate of major adverse cardiovascular events(MACE)was compared among all groups within 30 d.The risk factors of main negative cardiovascular events were analyzed by using multivariable Cox regression analysis,OR and 95%CI were calculated,and predictive cut-off level was analyzed by using ROC curve.Results The incidence rate of MACE within 30 d was higher in group 2 than that in group 1(P<0.05),and was higher in group 3 than that in group 4(P<0.05).The incidence rate of MACE within 30 d was the lowest in group 1,and was the highest in group 4(P<0.05).The predictive cut-off level of admission hyperglycemia to MACE was 157 mg/dl in all patients,145 mg/dl to non-diabetes group and 178 mg/dL to diabetes group.Conclusion The level of admission blood sugar can be an independent predictive index for short-term MACE in NSTEMI patients undergone PCI with or without diabetes.The different blood sugar states and admission hyperglycemia have different predictive cut-off level to incidence rate of MACE.