Aronson Doron, Hammerman Haim, Suleiman Mahmoud, Markiewicz Walter
Department of Cardiology, Rambam Medical Center, and Bruce Rappaport Faculty of Medicine, Haifa, Israel.
Am J Cardiol. 2009 Oct 15;104(8):1013-7. doi: 10.1016/j.amjcard.2009.05.053. Epub 2009 Aug 28.
Stress hyperglycemia is a complex phenomenon that incorporates the cumulative effects of multiple factors. Rapid changes in blood glucose may reflect neurohormonal and homodynamic events that affect patient outcome. We prospectively studied the relation between changes in fasting glucose (FG) during a hospital course and long-term mortality in 1,467 nondiabetic patients with acute myocardial infarction. FG was obtained at admission and later during the hospital course and classified at each time point as normal (<100 mg/dl), impaired (100 to 125 mg/dl), or diabetic range (>or=126 mg/dl). The relation between measurements of FG and mortality (median follow-up 30 months) was assessed using Cox models. FG classification improved in 426 (29.0%) and worsened in 248 patients (16.9%) during hospitalization. Mean FG was a better predictor of mortality than baseline or final FG levels alone (C-index 0.670, 0.656, and 0.645, respectively). Changes in FG during hospitalization were strongly associated with changes in mortality risk. Compared to patients with persistent normal FG, the adjusted hazard ratio (HR) for mortality was 2.6 (95% confidence interval [CI] 1.0 to 7.2) for patients in whom FG increased to the diabetic range; the HR was 6.3 (95% CI 4.0 to 10.4) in patients with persistent FG in the diabetic range but decreased substantially when FG normalized during hospitalization (HR 2.7, 95% CI 1.3 to 5.1). In conclusion, persistent increase of FG during hospitalization for acute myocardial infarction has greater prognostic effect than baseline FG. Changes in FG during hospitalization are simple and sensitive indicators of dynamic changes in risk.
应激性高血糖是一种复杂的现象，它包含多种因素的累积效应。血糖的快速变化可能反映了影响患者预后的神经激素和血液动力学事件。我们前瞻性地研究了1467例非糖尿病急性心肌梗死患者住院期间空腹血糖（FG）变化与长期死亡率之间的关系。在入院时及随后的住院过程中获取FG，并在每个时间点将其分类为正常（<100mg/dl）、受损（100至125mg/dl）或糖尿病范围（≥126mg/dl）。使用Cox模型评估FG测量值与死亡率（中位随访30个月）之间的关系。住院期间，426例（29.0%）患者的FG分类改善，248例（16.9%）患者的FG分类恶化。平均FG比单独的基线或最终FG水平更能预测死亡率（C指数分别为0.670、0.656和0.645）。住院期间FG的变化与死亡风险的变化密切相关。与FG持续正常的患者相比，FG升高至糖尿病范围的患者的校正风险比（HR）为2.6（95%置信区间[CI]1.0至7.2）；FG持续处于糖尿病范围但住院期间FG大幅下降（HR 2.7，95%CI 1.3至5.1）的患者的HR为6.3（95%CI 4.0至10.4）。总之，急性心肌梗死住院期间FG的持续升高比基线FG具有更大的预后影响。住院期间FG的变化是风险动态变化的简单而敏感的指标。
