急性冠脉综合征患者入院时血糖及糖化血红蛋白水平的预后价值

Prognostic value of admission glucose and glycosylated haemoglobin levels in acute coronary syndromes.

作者信息

Timmer J R, Ottervanger J P, Bilo H J G, Dambrink J H E, Miedema K, Hoorntje J C A, Zijlstra F

机构信息

Department of Cardiology, Isala Klinieken, Groot Wezenland 20, 8011 J W Zwolle, The Netherlands.

出版信息

QJM. 2006 Apr;99(4):237-43. doi: 10.1093/qjmed/hcl028. Epub 2006 Feb 27.

DOI:10.1093/qjmed/hcl028

PMID:16504985

Abstract

BACKGROUND

Admission hyperglycaemia is associated with poorer prognosis in patients with an acute coronary syndrome (ACS). Whether hyperglycaemia is more important than prior long-term glucose metabolism, is unknown.

AIM

To investigate the prognostic value of admission glucose and HbA(1c) levels in patients with ACS.

METHODS

We measured glucose and HbA(1c) at admission in 521 consecutive patients with suspected ACS. Glucose was categorized as <7.8 (n = 305), 7.8-11.0 (n = 138) or > or =11.1 mmol/l (n = 78); HbA(1c) as <6.2% (n = 420) or > or =6.2% (n = 101). Mean follow-up was 1.6 +/- 0.5 years.

RESULTS

The diagnosis of ACS was confirmed in 332 patients (64%), leaving 189 (36%) with atypical chest pain. In ACS patients, mortality by glucose category (<7.8, 7.8-11.0 or > or =11.1 mmol) was 9%, 8% and 25%, respectively (p = 0.001); mortality by HbA(1c) category (<6.2% vs. > or =6.2%) was 10% vs. 17%, respectively (p = 0.14). On multivariate analysis, glucose category was significantly associated with mortality (HR 3.0, 95% CI 1.1-8.3), but HbA(1c) category was not (HR 1.5, 95%CI 0.6-4.2).

DISCUSSION

Elevated admission glucose appears more important than prior long-term abnormal glucose metabolism in predicting mortality in patients with suspected ACS.

摘要

背景

急性冠状动脉综合征（ACS）患者入院时高血糖与预后较差相关。高血糖是否比先前的长期糖代谢更重要尚不清楚。

目的

研究入院时血糖和糖化血红蛋白（HbA1c）水平对ACS患者的预后价值。

方法

我们对521例连续疑似ACS患者入院时的血糖和HbA1c进行了测量。血糖分为<7.8 mmol/l（n = 305）、7.8 - 11.0 mmol/l（n = 138）或≥11.1 mmol/l（n = 78）；HbA1c分为<6.2%（n = 420）或≥6.2%（n = 101）。平均随访时间为1.6±0.5年。

结果

332例患者（64%）确诊为ACS，189例（36%）有非典型胸痛。在ACS患者中，按血糖类别（<7.8、7.8 - 11.0或≥11.1 mmol/l）划分的死亡率分别为9%、8%和25%（p = 0.001）；按HbA1c类别（<6.2%与≥6.2%）划分的死亡率分别为10%和17%（p = 0.14）。多因素分析显示，血糖类别与死亡率显著相关（HR 3.0，95%CI 1.1 - 8.3），但HbA1c类别与死亡率无关（HR 1.5，95%CI 0.6 - 4.2）。