Department of Geriatrics and Metabolic Diseases, Second University of Naples, 80138 Naples, Italy.
J Clin Endocrinol Metab. 2012 Aug;97(8):2862-71. doi: 10.1210/jc.2012-1364. Epub 2012 May 25.
We examined the effects of peri-procedural intensive glycemic control (IGC) during early percutaneous coronary intervention (PCI) on restenosis rate in hyperglycemic patients with ST-segment elevation myocardial infarction (STEMI).
A total of 165 hyperglycemic patients (glucose ≥ 140 mg/dl) with first STEMI undergoing PCI were studied. Patients were randomized to IGC for almost 24 h after PCI (n = 82; glucose, 80-140 mg/dl) followed by multidose sc insulin during the hospital stay or conventional glycemic control (CGC; n = 83; glucose, 180-200 mg/dl) followed by conventional therapy. Coronary angiography was performed at study entry and at 6-month follow-up. Blood samples for glycemia, hemoglobin A1c, inflammatory markers (C-reactive protein and TNF-α), monocyte chemoattractant-protein-1, and oxidative stress (nitrotyrosine) were collected immediately before and 24 h, 30 and 180 d after PCI.
After insulin infusion, mean plasma glucose during the peri-procedural period was greater in the CGC group than in the IGC group (CGC, 191 ± 15 mg/dl; IGC, 145 ± 35 mg/dl; P < 0.001). After the insulin infusion period, the levels of markers of oxidative stress (nitrotyrosine), inflammation (C-reactive protein, TNF-α), and monocyte chemoattractant-protein-1 were significantly higher in CGC patients compared with IGC patients. Moreover, ICG during PCI reduces restenosis by half (48 and 24%) at 6 months. During follow-up, there was no difference in mortality rates, glucose, inflammatory and oxidative stress markers among the groups. In-stent restenosis was positively associated with mean plasma glucose levels as well as oxidative stress and inflammatory markers during the insulin infusion period.
In hyperglycemic patients with STEMI, optimal peri-procedural glycemic control by reducing oxidative stress and inflammation may improve the outcome after PCI.
我们研究了经皮冠状动脉介入治疗（PCI）期间强化血糖控制（IGC）对并发高血糖的 ST 段抬高型心肌梗死（STEMI）患者再狭窄率的影响。
共纳入 165 例接受 PCI 的高血糖（血糖≥140mg/dl）首发 STEMI 患者。患者随机分为两组：PCI 后近 24 小时进行 IGC（血糖 80-140mg/dl，n=82），并在住院期间接受多次皮下胰岛素注射；或进行常规血糖控制（CGC，血糖 180-200mg/dl，n=83），并接受常规治疗。在研究入组时和 6 个月随访时进行冠状动脉造影。在 PCI 前和 24 小时、30 天和 180 天时采集血糖、糖化血红蛋白、炎症标志物（C 反应蛋白和 TNF-α）、单核细胞趋化蛋白-1 和氧化应激（硝基酪氨酸）的血样。
CGC 组患者在围手术期期间的平均血浆葡萄糖水平高于 IGC 组（CGC 组为 191±15mg/dl，IGC 组为 145±35mg/dl；P＜0.001）。在胰岛素输注期结束后，CGC 组患者的氧化应激标志物（硝基酪氨酸）、炎症标志物（C 反应蛋白、TNF-α）和单核细胞趋化蛋白-1 的水平明显高于 IGC 组患者。此外，PCI 期间的 IGC 可使 6 个月时的再狭窄率降低一半（48%和 24%）。在随访期间，各组之间的死亡率、血糖、炎症和氧化应激标志物无差异。支架内再狭窄与胰岛素输注期间的平均血浆葡萄糖水平以及氧化应激和炎症标志物呈正相关。
在并发高血糖的 STEMI 患者中，通过降低氧化应激和炎症反应来实现围手术期血糖的最佳控制可能会改善 PCI 后的结果。
