首发性心肌梗死患者的应激性高血糖症。

Stress hyperglycaemia in patients with first myocardial infarction.

机构信息

Department of Endocrinology and Diabetology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.

出版信息

Int J Clin Pract. 2012 Jun;66(6):592-601. doi: 10.1111/j.1742-1241.2012.02917.x.

DOI:10.1111/j.1742-1241.2012.02917.x

PMID:22607511

Abstract

OBJECTIVE

To investigate the incidence of stress hyperglycaemia at first acute myocardial infarction (MI) with ST-segment elevation, occurrence of stress hyperglycaemia as a manifestation of previously undiagnosed abnormal glucose tolerance (AGT), and its relation to stress hormone levels.

MATERIALS AND METHODS

The population of this prospective cohort study consisted of 243 patients. On admission glucose, adrenaline, noradrenaline and cortisol levels were measured. Patients without previously diagnosed diabetes (n = 204) underwent an oral glucose tolerance test on day 3 of hospitalisation and 3 months after discharge.

RESULTS

Abnormal glucose tolerance at day 3 was observed in 92 (45.1%) patients without a previous diagnosis of diabetes mellitus and resolved after 3 months in 46 (50.0%) patients (p < 0.0001). Stress hyperglycaemia, defined as admission glycaemia ≥ 11.1 mmol/l, affected 34 (14.0%) study participants: 28 (54.9%) patients with diabetes vs. 3 (8.8%) subjects with newly detected impaired glucose intolerance (p < 0.00001) and 1 (2.2%) person with AGT at day 3 (p < 0.000001). Multivariable analysis identified elevated glycated haemoglobin (HbA(1c) ; p < 0.0000001), anterior MI (p < 0.05) and high admission cortisol concentration (p < 0.001), but not catecholamines, as independent predictors of stress hyperglycaemia. The receiver operating characteristic curve analysis revealed the optimal cut-off values of 8.2% for HbA(1c) and 47.7 μg/dl for admission cortisol with very good and sufficient diagnostic accuracies respectively.

CONCLUSIONS

Newly detected AGT in patients with a first MI is transient in 50% of cases. Stress hyperglycaemia is a common finding in patients with a first MI with ST-segment elevation and diabetes mellitus, but is rarely observed in individuals with impaired glucose tolerance or transient AGT diagnosed during the acute phase of MI. The risk factors of stress hyperglycaemia occurrence include elevated HbA(1c) , anterior MI and high admission cortisol concentration.

摘要

目的

探讨 ST 段抬高型首次急性心肌梗死（MI）时应激性高血糖的发生率、应激性高血糖作为先前未诊断的异常葡萄糖耐量（AGT）的表现，以及其与应激激素水平的关系。

材料与方法

本前瞻性队列研究的人群包括 243 例患者。入院时测量血糖、肾上腺素、去甲肾上腺素和皮质醇水平。204 例无先前诊断糖尿病的患者在入院第 3 天和出院后 3 个月进行口服葡萄糖耐量试验。

结果

无糖尿病史的 92 例（45.1%）患者在第 3 天出现异常葡萄糖耐量，3 个月后有 46 例（50.0%）患者恢复正常（p<0.0001）。应激性高血糖定义为入院血糖≥11.1mmol/l，影响 34 例（14.0%）研究参与者：28 例（54.9%）糖尿病患者与 3 例（8.8%）新发糖耐量受损患者（p<0.00001）和 1 例（2.2%）第 3 天 AGT 患者（p<0.000001）。多变量分析确定糖化血红蛋白（HbA(1c)）升高（p<0.0000001）、前壁 MI（p<0.05）和高入院皮质醇浓度（p<0.001），但儿茶酚胺不是应激性高血糖的独立预测因素。受试者工作特征曲线分析显示，HbA(1c)的最佳截断值为 8.2%，入院皮质醇的最佳截断值为 47.7μg/dl，其诊断准确性均非常好和充足。