入院时高血糖与 ST 段抬高型心肌梗死患者微血管阻塞的关系。
Association between hyperglycemia at admission and microvascular obstruction in patients with ST-segment elevation myocardial infarction.
机构信息
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
出版信息
J Cardiol. 2015 Apr;65(4):272-7. doi: 10.1016/j.jjcc.2014.10.013. Epub 2014 Dec 19.
BACKGROUND
Blood glucose level at admission in ST-segment elevation myocardial infarction (STEMI) is a predictor of heart failure and mortality. A previous study showed the association between hyperglycemia and microvascular dysfunction using myocardial contrast echocardiography. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance imaging (CMR) can demonstrate microvascular obstruction (MVO) as the area with hypointense core within LGE. This study was performed to investigate the association between hyperglycemia at admission and MVO using CMR in patients with STEMI.
METHODS
Ninety-three patients with first STEMI who were treated by percutaneous coronary intervention (PCI) were included. CMR was performed within 7 days after PCI. Venous blood was collected routinely immediately after admission for plasma glucose determination before intravenous injection of some medications. Samples were analyzed in the hospital's central laboratory. We performed LGE-CMR to assess the presence of MVO.
RESULTS
MVO was found in 34 (37%) of all 93 patients; their glucose level at admission was significantly higher than that of patients who did not exhibit MVO [204 (153-267)mg/dl vs. 157 (127-200)mg/dl, p=0.002]. There were no differences in glycosylated hemoglobin and incidence of diabetes mellitus between the two groups. A multivariable logistic regression analysis showed that glucose level at admission was an independent predictor of MVO (odds ratio, 1.014; 95% confidence interval, 1.004 to 1.023; p=0.006). The glucose level at admission 190mg/dl was the best threshold value for identifying MVO. The occurrence of MVO was significantly higher in the patients with glucose level at admission ≧190mg/dl compared with the patients with glucose level <190mg/dl [18 (53%) vs. 16 (27%), p=0.023].
CONCLUSIONS
Hyperglycemia at admission in STEMI patients who were treated by PCI was associated with the presence of MVO assessed by LGE-CMR.
背景
ST 段抬高型心肌梗死（STEMI）患者入院时的血糖水平是心力衰竭和死亡率的预测因素。先前的一项研究表明，使用心肌对比超声心动图可以观察到高血糖与微血管功能障碍之间的关联。钆延迟增强（LGE）心血管磁共振成像（CMR）可以显示微血管阻塞（MVO），即 LGE 内低信号核心区域。本研究旨在通过 CMR 探讨 STEMI 患者入院时的高血糖与 MVO 之间的关系。
方法
共纳入 93 例接受经皮冠状动脉介入治疗（PCI）的首次 STEMI 患者。在 PCI 后 7 天内进行 CMR。静脉血在入院后立即采集，用于在静脉注射某些药物前测定血浆葡萄糖。标本在医院中心实验室进行分析。我们进行 LGE-CMR 以评估 MVO 的存在。
结果
93 例患者中，34 例（37%）存在 MVO；与未发生 MVO 的患者相比，其入院时的血糖水平显著更高[204（153-267）mg/dl 比 157（127-200）mg/dl，p=0.002]。两组间糖化血红蛋白和糖尿病发生率无差异。多变量逻辑回归分析显示，入院时的血糖水平是 MVO 的独立预测因素（比值比，1.014；95%置信区间，1.004 至 1.023；p=0.006）。入院时血糖水平 190mg/dl 是识别 MVO 的最佳阈值。与入院时血糖水平 <190mg/dl 的患者相比，血糖水平≧190mg/dl 的患者 MVO 的发生率显著更高[18 例（53%）比 16 例（27%），p=0.023]。
结论
经 PCI 治疗的 STEMI 患者入院时的高血糖与 LGE-CMR 评估的 MVO 有关。
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