Ishihara Masaharu, Kojima Sunao, Sakamoto Tomohiro, Kimura Kazuo, Kosuge Masami, Asada Yujiro, Tei Chuwa, Miyazaki Shunichi, Sonoda Masahiro, Tsuchihashi Kazufumi, Yamagishi Masakazu, Shirai Mutsunori, Hiraoka Hisatoyo, Honda Takashi, Ogata Yasuhiro, Ogawa Hisao
Department of Cardiology, Hiroshima City Hospital, Hiroshima, Kumamoto University School of Medicine, Kumamoto, Japan.
Am J Cardiol. 2009 Sep 15;104(6):769-74. doi: 10.1016/j.amjcard.2009.04.055. Epub 2009 Jul 25.
Previous studies have reported that acute hyperglycemia is associated with high mortality after acute myocardial infarction (AMI). However, optimal plasma glucose level may be different between diabetic and nondiabetic patients. The purpose of this study was to assess the relation between admission glucose and in-hospital mortality after AMI in patients with and without diabetes. This study consisted of 3,750 patients who were admitted to the 35 hospitals participating to the Japanese Acute Coronary Syndrome Study (JACSS) group within 48 hours after the onset of AMI. Plasma glucose was measured at the time of hospital admission. In patients without a history of diabetes, there was a linear relation between admission glucose and in-hospital mortality. Nondiabetic patients with a glucose level <6 mmol/L had the lowest mortality (2.5%). As admission glucose increased by 1 mmol/L, mortality increased by 17% (13% to 21%, p <0.001). In patients with a history of diabetes, however, there was a U-shape relation between glucose and mortality. Diabetic patients with glucose 9 to 10 mmol/L had the lowest mortality (1.9%); not only severe hyperglycemia (glucose > or =11 mmol/L, 9.1%, p <0.001) but also euglycemia (glucose <7 mmol/L, 9.4%, p = 0.009) were associated with higher mortality compared to moderate hyperglycemia (glucose 9 to 11 mmol/L, 3.2%). Diabetic patients with admission glucose 9 to 10 mmol/L had the lowest mortality, whereas lower glucose was better in nondiabetic patients. In conclusion, optimal glucose level on admission may be different between diabetic and nondiabetic patients with AMI.
既往研究报道，急性高血糖与急性心肌梗死（AMI）后高死亡率相关。然而，糖尿病患者与非糖尿病患者的最佳血糖水平可能有所不同。本研究的目的是评估糖尿病和非糖尿病AMI患者入院时血糖水平与院内死亡率之间的关系。本研究纳入了3750例在AMI发病后48小时内入住参与日本急性冠状动脉综合征研究（JACSS）组的35家医院的患者。入院时测定血浆葡萄糖水平。在无糖尿病病史的患者中，入院血糖与院内死亡率呈线性关系。血糖水平<6 mmol/L的非糖尿病患者死亡率最低（2.5%）。随着入院血糖每升高1 mmol/L，死亡率增加17%（13%至21%，p<0.001）。然而，在有糖尿病病史的患者中，血糖与死亡率呈U形关系。血糖为9至10 mmol/L的糖尿病患者死亡率最低（1.9%）；与中度高血糖（血糖9至11 mmol/L，3.2%）相比，严重高血糖（血糖≥11 mmol/L，9.1%，p<0.001）和血糖正常（血糖<7 mmol/L，9.4%，p = 0.009）均与较高死亡率相关。入院血糖为9至10 mmol/L的糖尿病患者死亡率最低，而在非糖尿病患者中血糖越低越好。总之，AMI的糖尿病和非糖尿病患者入院时的最佳血糖水平可能不同。
