Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan.
Circ J. 2012;76(3):563-71. doi: 10.1253/circj.cj-11-1376. Epub 2012 Jan 27.
Acute hyperglycemia is a common feature during the early phase after acute myocardial infarction (AMI), regardless of diabetes status. Numerous studies have demonstrated that patients with AMI and hyperglycemia on admission have high rates of mortality. It has been reported that there is a linear positive relation between admission blood glucose levels and mortality after AMI. However, recent studies showed that the relationship is U-shaped in patients with a history of diabetes. Diabetic patients with moderate hyperglycemia (glucose 9-11 mmol/L) had the lowest mortality and not only severe hyperglycemia (glucose ≥ 11 mmol/L) but also euglycemia (glucose < 7 mmol/L) was associated with higher mortality. Although it has been debated whether acute hyperglycemia is causally related to adverse outcomes after AMI or is simply an epiphenomenon of severely damaged myocardium, multiple physiological studies have demonstrated that hyperglycemia has a direct detrimental effect on ischemic myocardium through several mechanisms, including oxidative stress, inflammation, apoptosis, endothelial dysfunction, hypercoagulation, platelet aggregation and impairment of ischemic preconditioning. Current guidelines recommend the use of an insulin-based regimen to achieve and maintain glucose levels < 10.0 mmol/dl, and emphasize the avoidance of hypoglycemia. However, the optimal management goal of glucose levels for patients with acute hyperglycemia remains uncertain. Further studies are warranted into the appropriate management in patients with AMI and acute hyperglycemia.
急性高血糖是急性心肌梗死（AMI）早期的常见特征，无论糖尿病状态如何。大量研究表明，AMI 患者入院时血糖升高与死亡率高有关。据报道，入院时血糖水平与 AMI 后死亡率之间存在线性正相关关系。然而，最近的研究表明，对于有糖尿病史的患者，这种关系呈 U 型。糖尿病患者中度高血糖（血糖 9-11mmol/L）死亡率最低，不仅严重高血糖（血糖≥11mmol/L），而且血糖正常（血糖<7mmol/L）也与更高的死亡率相关。尽管急性高血糖是否与 AMI 后不良结局有因果关系，还是仅仅是严重受损心肌的一种表现，这一问题一直存在争议，但多项生理学研究表明，高血糖通过多种机制对缺血心肌产生直接的有害影响，包括氧化应激、炎症、细胞凋亡、内皮功能障碍、高凝状态、血小板聚集和缺血预适应受损。目前的指南建议使用胰岛素治疗方案将血糖控制在<10.0mmol/dl，并强调避免低血糖。然而，急性高血糖患者的血糖最佳管理目标仍不确定。需要进一步研究 AMI 合并急性高血糖患者的适当管理方法。
