既往无糖尿病诊断的急性心肌梗死患者的葡萄糖代谢：一项前瞻性研究。

Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study.

作者信息

Norhammar Anna, Tenerz Ake, Nilsson Göran, Hamsten Anders, Efendíc Suad, Rydén Lars, Malmberg Klas

机构信息

Department of Cardiology, Karolinska Hospital, 171 76 Stockholm, Sweden.

出版信息

Lancet. 2002 Jun 22;359(9324):2140-4. doi: 10.1016/S0140-6736(02)09089-X.

DOI:10.1016/S0140-6736(02)09089-X

PMID:12090978

Abstract

BACKGROUND

Glycometabolic state at hospital admission is an important risk marker for long-term mortality in patients with acute myocardial infarction, whether or not they have known diabetes mellitus. Our aim was to ascertain the prevalence of impaired glucose metabolism in patients without diagnosed diabetes but with myocardial infarction, and to assess whether such abnormalities can be identified in the early course of a myocardial infarction.

METHODS

We did a prospective study, in which we enrolled 181 consecutive patients admitted to the coronary care units of two hospitals in Sweden with acute myocardial infarction, no diagnosis of diabetes, and a blood glucose concentration of less than 11.1 mmol/L. We recorded glucose concentrations during the hospital stay, and did standardised oral glucose tolerance tests with 75 g of glucose at discharge and again 3 months later.

FINDINGS

The mean age of our cohort was 63.5 years (SD 9) and the mean blood glucose concentration at admission was 6.5 mmol/L (1.4). The mean 2-h postload blood glucose concentration was 9.2 mmol/L (2.9) at hospital discharge, and 9.0 mmol/L (3.0) 3 months later. 58 of 164 (35%, 95% CI 28-43) and 58 of 144 (40%, 32-48) individuals had impaired glucose tolerance at discharge and after 3 months, respectively, and 51 of 164 (31%, 24-38) and 36 of 144 (25%, 18-32) had previously undiagnosed diabetes mellitus. Independent predictors of abnormal glucose tolerance at 3 months were concentrations of HbA(1c) at admission (p=0.024) and fasting blood glucose concentrations on day 4 (p=0.044).

INTERPRETATION

Previously undiagnosed diabetes and impaired glucose tolerance are common in patients with an acute myocardial infarction. These abnormalities can be detected early in the postinfarction period. Our results suggest that fasting and postchallenge hyperglycaemia in the early phase of an acute myocardial infarction could be used as early markers of high-risk individuals.

摘要

背景

无论急性心肌梗死患者是否患有已知糖尿病，入院时的糖代谢状态都是长期死亡率的重要风险标志物。我们的目的是确定未诊断出糖尿病但患有心肌梗死患者的糖代谢受损患病率，并评估在心肌梗死早期是否能识别出此类异常情况。

方法

我们进行了一项前瞻性研究，纳入了瑞典两家医院冠心病监护病房连续收治的181例急性心肌梗死患者，这些患者未诊断出糖尿病，且血糖浓度低于11.1 mmol/L。我们记录了住院期间的血糖浓度，并在出院时和3个月后进行了标准的口服葡萄糖耐量试验，使用75克葡萄糖。

结果

我们队列的平均年龄为63.5岁（标准差9），入院时的平均血糖浓度为6.5 mmol/L（1.4）。出院时平均2小时餐后血糖浓度为9.2 mmol/L（2.9），3个月后为9.0 mmol/L（3.0）。164例患者中有58例（35%，95%可信区间28 - 43）在出院时糖耐量受损，144例患者中有58例（40%，32 - 48）在3个月后糖耐量受损，164例患者中有51例（31%，24 - 38）和144例患者中有36例（25%，18 - 32）此前未诊断出患有糖尿病。3个月时糖耐量异常的独立预测因素是入院时的糖化血红蛋白（HbA₁c）浓度（p = 0.024）和第4天的空腹血糖浓度（p = 0.044）。