应激性高血糖对急性冠脉综合征患者心率变异性及预后的影响

Effects of stress hyperglycemia on heart rate variability and prognosis of patients with acute coronary syndrome

目的观察合并应激性高血糖(SHG)的急性冠脉综合征(ACS)患者与不并应激性高血糖的急性冠脉综合征患者心率变异性(HRV)以及1年不良事件发生情况,探讨应激性高血糖对急性冠脉综合征患者心率变异性及预后的影响。方法入选108例无糖尿病史的ACS患者,根据入院时血糖情况分为应激性高血糖组(SH)组40例和非应激性高血糖组(非SH)组68例。比较2组患者基线情况,住院期间HRV,72 h炎性、氧化应激及心衰指标(hs-CRP、MDA、SOD、NT-proBNP),1周、3个月心脏超声指标,住院期间心脏事件发生情况,出院后随访12个月主要心血管不良事件(MACE)。结果SH组各项心率变异性指标(SDNN、SDNNindex、SDANN、RMSSD、PNN50、低频谱、高频谱)显著低于非SH组(P<0.05);入院时LVEF、LVESV、LVEDV2组间无明显差异,发病后1周及3个月时,SH组LVEF水平明显低于非SH组(P<0.05),LVESV、LVEDV水平SH组均高于非SH组(P<0.05);hs-CRP、MDA以及NT-proBNP水平SH组明显高于非SH组(P<0.05);SOD水平SH组明显低于非SH组(P<0.05);SH组住院期间MACE事件发生率以及12月内MACE事件发生率均明显高于非SH组(P<0.05)。结论ACS患者伴发应激性高血糖后,其HRV指标明显降低,血清炎症指标、氧化应激指标以及心衰指标明显升高,心脏结构功能受损更加严重,预后更差,说明伴发SH后患者体内炎性反应以及氧化应激反应更加明显,导致心脏自主神经调节功能明显降低,加重ACS对心脏结构及心功能的影响,这一系列不良反应将增加ACS后不良事件的发生率,进而影响患者预后。

Objective To investigate the effects of stress hyperglycemia on heart rate variability(HRV)and prognosis of patients with acute coronary syndrome(ACS)by observing the HRV and 1-year incidence rate of adverse events of ACS patients with or without stress hyperglycemia.Methods A total of 108 ACS patients without history of diabetes were enrolled in the study,who were divided into stress hyperglycemia group(SH group,n=40)and non-stress hyperglycemia group(non-SH group,n=68)according to the blood glucose status on admission.the baseline data,HRV,72-hour inflammatory,oxidative stress and heart failure indexes(hs-CRP,MDA,SOD,NT-proBNP),1-week and 3-month cardiac ultrasound indexes as well as the incidence rate of mian cadiovascular adverse events(MACE)after 12-month follow up were observed and compared between the two groups.Results The HRV indexes(SDNN,SDNNindex,SDANN,RMSSD,PNN50,low frequency spectrum and high frequency spectrum)in SH group were significantly lower than those in non-SH group(P<0.05).On admission there were no significant differences in the levels of LVEF,LVESV,and LVEDV between the two groups.At 1 week and 3 months after admission,the levels of LVEF and SOD in SH group were significantly lower than those in non-SH group,however,the levels of LVESV,LVEDV,hs-CRP,MDA and NT-proBNP were significantly higher than those in non-SH group(P<0.05).In addition the incidence rates of MACE during hospitalization and within 12 months in SH group were significantly higher than those in non-SH group(P<0.05).Conclusion In ACS patients complicated by stress hyperglycemia,the HRV indexes are significantly decreased,however,the serum levels of inflammation indicators,oxidative stress indexes,and heart failure indexes are significantly increased,which suggests that inflammatory reactions and oxidative stress reactions are more obvious in ACS patients complicated by stress hyperglycemia,which result in the increase the incidence of adverse events after ACS,thereby affecting the prognosis of patients.