Intensive Cardiac Coronary Unit, Department of Heart and Vessel, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
Acta Diabetol. 2013 Jun;50(3):293-300. doi: 10.1007/s00592-011-0325-6. Epub 2011 Oct 9.
In the setting of acute myocardial infarction, hyperglycemia and acute insulin resistance may represent a stress response to myocardial injury mainly related to acute catecholamine release. By measuring glucose values and insulin resistance (Homeostatic Model Assessment index-HOMA), we evaluated in 356 non-diabetic patients with ST-elevation myocardial infarction (STEMI) undergone mechanical revascularization: (a) the acute glycometabolic response by evaluating insulin resistance, glucose levels, and their combination and (b) whether insulin resistance and increased glucose values (and their combination) are able to affect in-Intensive Cardiac Care Unit (ICCU) mortality and complications. In the overall population, 226 (63.5%) patients showed glucose values ≤140 mg/dl (group B), while 130 patients had glucose values >140 mg/dl (group A) (36.5%). Within group B, insulin resistance (as inferred by positive HOMA index) was present in 125 patients (55.3%), whereas 101 patients (44.7%) exhibited normal values of HOMA index. Within group A, 109 patients (83.8%) were insulin resistant, while 21 patients (16.2%) had normal values of HOMA index. At multivariable analysis, glucose values were independently associated with in-ICCU mortality (OR: 7.387; 95% CI 2.701-20.201; P < 0.001) and complications (OR: 1.786; 95% CI 1.089-2.928; P = 0.022). In the early phase of STEMI, the acute glycometabolic response to stress is heterogeneous (ranging from no insulin resistance to glucose levels >140 mg/dl and, finally, to the combination of increased glucose values and insulin resistance). Increased glucose values are stronger prognostic factors since they are independently associated with in-ICCU mortality and complications.
在急性心肌梗死的情况下，高血糖和急性胰岛素抵抗可能代表一种主要与急性儿茶酚胺释放有关的心肌损伤应激反应。通过测量血糖值和胰岛素抵抗（稳态模型评估指数-HOMA），我们评估了 356 例接受机械血运重建的 ST 段抬高型心肌梗死（STEMI）的非糖尿病患者：（a）通过评估胰岛素抵抗、血糖水平及其组合来评估急性糖代谢反应；（b）胰岛素抵抗和升高的血糖值（及其组合）是否能够影响重症监护病房（ICU）内的死亡率和并发症。在整个人群中，226 例（63.5%）患者的血糖值≤140mg/dl（B 组），而 130 例患者的血糖值>140mg/dl（A 组）（36.5%）。在 B 组中，125 例（55.3%）存在胰岛素抵抗（正 HOMA 指数推断），而 101 例（44.7%）HOMA 指数正常。在 A 组中，109 例（83.8%）存在胰岛素抵抗，而 21 例（16.2%）HOMA 指数正常。多变量分析显示，血糖值与 ICU 内死亡率（OR：7.387；95%CI 2.701-20.201；P<0.001）和并发症（OR：1.786；95%CI 1.089-2.928；P=0.022）独立相关。在 STEMI 的早期阶段，应激引起的急性糖代谢反应是异质的（范围从无胰岛素抵抗到血糖值>140mg/dl，最后是血糖值升高和胰岛素抵抗的组合）。升高的血糖值是更强的预后因素，因为它们与 ICU 内死亡率和并发症独立相关。
