应激性高血糖对非糖尿病急性心肌梗死患者PCI术后心肌灌注、预后的影响

Effects of stress hyperglycemia on myocardial perfusion and prognosis in non-diabetic patients with acute myocardial infarction after PCI

目的探讨应激性高血糖对非糖尿病急性心肌梗死患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后心肌灌注、预后的影响。方法选取2018年1月—2020年1月巨野县人民医院收治的非糖尿病急性心肌梗死患者100例,根据入组时随机血糖浓度分为正常血糖组(n=53)、应激性高血糖组(n=47),两组患者入院后完善相关检查,均采用PCI术治疗,比较两组患者PCI术后左心功能、心肌灌注情况,统计两组患者住院期间主要心血管不良事件(major adverse cardiac events,MACEs)的发生情况,分析应激性高血糖与院内死亡的相关性。结果与正常血糖组患者相比,应激性高血糖患者术后左室射血分数(left ventricular ejection fraction,LVEF)水平显著降低,心肌灌注水平更低,肌酸激酶同工酶(creatine kinase isoenzymes,CK-MB)峰值更高,心肌灌注分级(TIMI myocardial perfusion grades,TMPG)2~3级患者比例降低更明显,差异有统计学意义(P<0.05);应激性高血糖组患者的院内死亡率5.66%(3/47)较正常血糖组1.89%(1/52)高,但差异无统计学意义(P>0.05);心源性休克、严重恶性心律失常、充血性心力衰竭的发生率均显著高于正常血糖组,差异均有统计学意义(P<0.05)。Logistic多元回归法分析显示,应激性高血糖与患者PCI术后MACEs发生明显相关(OR=3.177,95%CI:1.920~5.284,P<0.001)。结论应激性高血糖会降低非糖尿病急性心肌梗死患者PCI术后心肌灌注水平,增加术后发生MACEs的风险,影响临床预后。

Objective:To investigate the effect of stress hyperglycemia on myocardial perfusion and prognosis of nondiabetic patients with acute myocardial infarction after PCI.Methods:A total of 100 patients with non-diabetic acute myocardial infarction admitted to our hospital from January 2018 to January 2020 were selected and divided into normal blood glucose group(n=53)and stress hyperglycemia group(n=47)according to blood glucose concentration at the time of enrollment.After admission,relevant examinations were completed and percutaneous coronary intervention(PCI)was used for treatment in both groups.Changes in left heart function and myocardial perfusion indexes after PCI were compared between the two groups.The incidence of major cardiovascular adverse events(MACEs)during hospitalization in the two groups was statistically analyzed,and the correlation between stress hyperglycemia and in-hospital death was analyzed.Results:Compared with the normal blood glucose group,the postoperative LVEF level of stress hyperglycemia patients was significantly decreased,the level of myocardial perfusion was lower,the peak value of CK-MB was higher,and the proportion of TMPG 2~3 patients decreased more obviously,and the difference was statistically significant(P<0.05).The hospital mortality of stress hyperglycemia group was 5.66%(3/47),which was higher than that of normal hyperglycemia group 1.89%(1/52),but the difference was not statistically significant(P>0.05).The incidences of cardiogenic shock,severe and malignant arrhythmia and congestive heart failure were significantly higher than those in the normal blood glucose group,and the difference was statistically significant(P<0.05).Logistic multiple regression analysis showed that stress hyperglycemia was significantly correlated with MACEs after PCI(OR=3.177,95%CI:1.920~5.284,P<0.001).Conclusion:Stress hyperglycemia can reduce the level of myocardial perfusion in non-diabetic patients with acute myocardial infarction after PCI increase the risk of postoperative MACEs,and affects the clinical prognosis of patients.