入院时血糖对直接血管成形术后心外膜和微血管血流的影响。

The influence of admission glucose on epicardial and microvascular flow after primary angioplasty.

作者信息

Shen Xu-hua, Jia San-qing, Li Hong-wei

机构信息

Department of Cardiology, Beijing Friendship Hospital, Beijing 100050, China.

出版信息

Chin Med J (Engl). 2006 Jan 20;119(2):95-102.

PMID:16454990

Abstract

BACKGROUND

Patients with elevated admission glucose levels may be at increased risk of death after myocardial infarction, independent of other baseline risk factors and more severe coronary artery disease. However, data regarding admission glucose and epicardial and microvascular flow after primary angioplasty is limited.

METHODS

Angioplasty was performed in 308 ST-segment elevated myocardial infarction patients. Patients were divided into 3 groups on the basis of admission glucose level: group 1, < 7.8 mmol/L; group 2, (7.8 - 11.0) mmol/L; and group 3, >or= 11.0 mmol/L.

RESULTS

Compared with group 1, patients in group 2 and group 3 were more often female and older. Triglycerides (TG) in group 3 were significantly higher than group 1. At angiography, they more frequently had 2-vessel or 3-vessel disease. In the infarct-related artery, there was no relationship between hyperglycemia and thrombolysis in myocardial infarction (TIMI) 3 flow after percutaneous coronary intervention (PCI) (89.7%, 86.0% and 86.3%, P = NS). However, corrected TIMI frame count (CTFC) in group 2 and group 3 were more than group 1. TIMI myocardial perfusion grade (TMPG) 0 - 1 grade among patients with hyperglycemia after PCI were more frequent (30.9% and 29.0% vs 17.3%, P < 0.05). There was less frequent complete ST - segment resolution (STR) and early T wave inversion among patients with hyperglycemia after PCI.

CONCLUSION

Elevated admission glucose levels in ST - segment elevation myocardial infarction patients treated with primary PCI are independently associated with impaired microvascular flow. Abnormal microvascular flow may contribute at least in part to the poor outcomes observed in patients with elevated admission glucose.

摘要

背景

入院时血糖水平升高的患者，心肌梗死后死亡风险可能增加，这与其他基线风险因素及更严重的冠状动脉疾病无关。然而，关于直接经皮冠状动脉介入治疗（PCI）后入院血糖与心外膜及微血管血流的数据有限。

方法

对308例ST段抬高型心肌梗死患者进行了血管成形术。根据入院时血糖水平将患者分为3组：第1组，血糖<7.8 mmol/L；第2组，血糖（7.8 - 11.0）mmol/L；第3组，血糖≥11.0 mmol/L。

结果

与第1组相比，第2组和第3组患者女性更多、年龄更大。第3组的甘油三酯（TG）显著高于第1组。血管造影显示，第2组和第3组患者双支或三支血管病变更为常见。在梗死相关动脉中，高血糖与PCI术后心肌梗死溶栓（TIMI）3级血流之间无相关性（分别为89.7%、86.0%和86.3%，P =无显著性差异）。然而，第2组和第3组的校正TIMI帧数（CTFC）多于第1组。PCI术后高血糖患者中TIMI心肌灌注分级（TMPG）0 - 1级更为常见（分别为30.9%和29.0%，对比17.3%，P < 0.05）。PCI术后高血糖患者完全ST段回落（STR）和早期T波倒置较少见。