应激性高血糖与非糖尿病急性心肌梗死预后相关性研究

The relationship between stress hyperglycemia and the prognosis of acute myocardial infarction without diabetes mellitus

目的探讨应激性高血糖(SHG)与非糖尿病急性心肌梗死(AMI)患者预后的相关性。方法采用回顾性队列研究的方法,选取首都医科大学宣武医院2018年1月到2020年12月不合并糖尿病或糖耐量异常(IGT)且入院糖化血红蛋白(HbA1c)≤6.0%的AMI患者396例。其中,238例患者入院时未发生SHG(A组),85例患者入院时发生SHG但血糖升高程度未达到糖尿病诊断标准(B组),73例患者入院时发生SHG且血糖升高程度达到糖尿病诊断标准(C组)。记录患者的基线数据和出院后主要不良心脑血管事件(MACCE)发生情况。采用多因素Cox回归分析影响非糖尿病AMI患者出院后发生MACCE的独立危险因素。结果B组和C组出院后MACCE发生率明显高于A组[29.4%(25/85)和35.6%(26/73)比18.5%(44/238)],C组明显高于B组,差异有统计学意义(P<0.05)。多因素Cox回归分析结果显示,入院发生SHG为非糖尿病AMI患者出院后发生MACCE的独立危险因素(P<0.05),入院LVEF为非糖尿病AMI患者出院后发生MACCE的独立保护因素(P<0.01)。结论入院发生SHG是非糖尿病AMI患者发生MACCE的独立危险因素。对于入院发生SHG的非糖尿病AMI患者提倡早发现、早评估并根据临床实际情况进行干预,以进一步改善非糖尿病AMI患者的预后。

Objective To analyze the relationship between stress hyperglycemia(SHG)and the prognosis of acute myocardial infarction(AMI)without diabetes mellitus(DM).Methods Using a retrospective cohort study method,396 AMI patients without DM or impaired glucose tolerance(IGT)and admitted glycated hemoglobin A1c(HbA1c)≤6.0%from January 2018 to December 2020 in Xuanwu Hospital,Capital Medical University were selected.Among them,238 patients did not have SHG at admission(group A),85 patients had SHG at admission but their blood glucose level did not reach the diagnostic criteria for DM(group B),and 73 patients had SHG at admission and their blood glucose level reached the diagnostic criteria for DM(group C).The baseline data and the incidence of main adverse cardiovascular and cerebrovascular events(MACCE)were recorded.Multivariate Cox regression was used to analyze the independent risk factors of MACCE after discharge in AMI patients without DM.Results The incidence of MACCE after discharge in group B and group C was significantly higher than that in group A:29.4%(25/85)and 35.6%(26/73)vs.18.5%(44/238),the incidence in group C was significantly higher than that in group B,and there was statistical difference(P<0.05).Multivariate Cox regression analysis result showed that SHG on admission was an independent risk factor for MACCE after discharge in AMI patients without DM(P<0.05),and LVEF on admission was an independent protective factor for MACCE after discharge in AMI patients without DM(P<0.01).Conclusions SHG on admission is the independent risk factor of MACCE in AMI patient without DM.Early detection,assessment and proper intervention measures based on clinical reality should be advocated for the AMI patients with SHG to further improve the prognosis.