[入院血糖水平对ST段抬高型心肌梗死预后的影响]

[The impact of admission blood glucose level on the prognosis of ST-segment elevation myocardial infarction].

作者信息

Liu Yao, Yang Yan-Min, Zhu Jun, Tan Hui-Qiong, Liang Yan, Liu Li-Sheng, Li Ying

机构信息

Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Emergency, Fuwai Hospital, Beijing, China.

出版信息

Zhonghua Nei Ke Za Zhi. 2009 Jun;48(6):465-8.

PMID:19954040

Abstract

OBJECTIVE

To evaluate the predictive value of admission blood glucose level for the mortality within 30-day and major adverse cardiac events(MACE) rate in patients with ST-segment elevation acute myocardial infarction (STEMI).

METHODS

An observational analysis of 7446 Chinese STEMI patients from a global randomized controlled trials of cases recruited within 12 hours of symptom onset was carried out. According to the levels of admission glucose (hyperglycemia was defined as admission glucose > 10 mmol/L) and known diagnosis of diabetes mellitus (DM), these patients were divided into four groups, I: no DM and normal glucose group (control group); II: DM but normal glucose group; III: no DM and hyperglycemia group; and IV: DM and hyperglycemia group.

RESULTS

Admission hyperglycemia was associated with a significantly higher 30-day mortality rate (group III 17.1% vs group I 8.6%, group IV 18.6% vs group I 8.6%, P < 0.001) and also an increased incidence of MACE (group III 36.3% vs group I 21.6%, group IV 38.8% vs group I 21.6%, P < 0.001). However, DM without admission hyperglycemia did not increase the 30-day mortality (group II 11.6% vs group I 8.6%, P = 0.096). Multivariate logistic regression analysis showed that compared with group I patients, group III and group IV had a risk of death of 1.51 fold ( OR 1.51, 95% CI 1.22-1.87, P <0.001) and 1.83 fold (OR 1.83, 95% CI 1.40-2.39, P <0.001) respectively; hyperglycemia was an independent predictor of 30-day mortality and an increase of 1 mmol/L in glucose level was associated with a 5% increase of mortality risk (OR 1.05, 95% CI 1.04-1.07, P <0.001), but DM without hyperglycemia was not so (OR 1.11, 95% CI 0.87-1.42, P = 0.412).

CONCLUSIONS

The rates of 30-day mortality and cardiovascular events are significantly higher in STEMI patients with acute hyperglycemia than in patients without. Hyperglycemia on admission is an independent risk factor for the short-term outcome of STEMI, but diabetes mellitus without hyperglycemia is not associated with the short-term mortality.

摘要

目的

评估ST段抬高型急性心肌梗死（STEMI）患者入院血糖水平对30天内死亡率及主要不良心脏事件（MACE）发生率的预测价值。

方法

对7446例中国STEMI患者进行观察性分析，这些患者来自一项全球随机对照试验，病例在症状发作后12小时内招募。根据入院血糖水平（高血糖定义为入院血糖>10 mmol/L）及已知的糖尿病（DM）诊断，将这些患者分为四组，I：无DM且血糖正常组（对照组）；II：有DM但血糖正常组；III：无DM且高血糖组；IV：有DM且高血糖组。

结果

入院高血糖与显著更高的30天死亡率相关（III组17.1% vs I组8.6%，IV组18.6% vs I组8.6%，P<0.001），且MACE发生率增加（III组36.3% vs I组21.6%，IV组38.8% vs I组21.6%，P<0.001）。然而，无入院高血糖的DM并未增加30天死亡率（II组11.6% vs I组8.6%，P = 0.096）。多因素logistic回归分析显示，与I组患者相比，III组和IV组的死亡风险分别为1.51倍（OR 1.51，95%CI 1.22 - 1.87，P<0.001）和1.83倍（OR 1.83，95%CI 1.40 - 2.39，P<0.001）；高血糖是30天死亡率的独立预测因素，血糖水平每升高1 mmol/L，死亡风险增加5%（OR 1.05，95%CI 1.04 - 1.07，P<0.001），但无高血糖的DM并非如此（OR 1.11，95%CI 0.87 - 1.42，P = 0.412）。