急性冠状动脉综合征患者强化胰岛素治疗联合葡萄糖-胰岛素-钾治疗：一项随机对照研究的一年随访结果。
One-Year Outcome of Intensive Insulin Therapy Combined to Glucose-Insulin-Potassium in Acute Coronary Syndrome: A Randomized Controlled Study.
机构信息
Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
Research Laboratory LR12SP18, University of Monastir, Tunisia.
出版信息
J Am Heart Assoc. 2017 Nov 14;6(11):e006674. doi: 10.1161/JAHA.117.006674.
BACKGROUND
A number of factors may offset the cardioprotective effects of glucose-insulin-potassium (GIK) on outcome of patients with acute coronary syndrome, such as hyperglycemia induced by this cocktail infusion. We performed a study to evaluate the effect of intensive insulin therapy in association with GIK on 1-year outcome in patients hospitalized for acute coronary syndrome.
METHODS AND RESULTS
In a randomized prospective controlled trial we included 772 patients with non-ST-segment elevation acute coronary syndrome. Patients were randomized into 3 groups: GIKI group, who received GIK with intensive insulin therapy for 24 hours; GIK group, who received GIK with nonintensive insulin therapy; and control group, who received usual care. The primary outcome criteria were the rates of major cardiovascular events combining death, reinfarction, and stroke rate at 1 year. In addition, we measured platelet function assay-100 and plasminogen activator inhibitor-1 at admission and 24 hours later. Based on an intention-to-treat analysis, major cardiovascular events at 1 year was 12.8% in the GIKI group, 15.5% in the GIK group, and 20.5% in the placebo group; the difference was significant between the GIK and control groups (=0.01). Platelet function assay-100 at 24 hours decreased significantly from baseline in the control group but not in the GIKI group. Plasminogen activator inhibitor-1 decreased significantly in the GIKI group but significantly increased in the control group. Minor hypoglycemic events were more frequent in the GIKI group compared with other groups.
CONCLUSIONS
GIKI led to improvement of 1-year outcome rates in patients with non-ST-segment elevation acute coronary syndrome. This beneficial effect was associated with a decrease in platelet reactivity and an increase on fibrinolysis tests.
CLINICAL TRIAL REGISTRATION
URL: https://www.clinicaltrials.gov. Unique identifier: NCT00965406.
背景
许多因素可能会抵消葡萄糖-胰岛素-钾（GIK）对急性冠状动脉综合征患者结局的心脏保护作用，例如这种鸡尾酒输注引起的高血糖。我们进行了一项研究，以评估在急性冠状动脉综合征住院患者中，与 GIK 联合使用强化胰岛素治疗对 1 年结局的影响。
方法和结果
在一项随机前瞻性对照试验中，我们纳入了 772 例非 ST 段抬高型急性冠状动脉综合征患者。患者随机分为 3 组：GIKI 组，接受 24 小时强化胰岛素治疗的 GIK；GIK 组，接受非强化胰岛素治疗的 GIK；对照组，接受常规治疗。主要终点为 1 年时主要心血管事件（包括死亡、再梗死和卒中）的发生率。此外，我们在入院时和 24 小时后测量血小板功能试验-100 和纤溶酶原激活物抑制剂-1。基于意向治疗分析，GIKI 组 1 年时主要心血管事件发生率为 12.8%，GIK 组为 15.5%，对照组为 20.5%；GIK 组与对照组之间的差异有统计学意义（=0.01）。对照组 24 小时时血小板功能试验-100 较基线显著下降，但 GIKI 组无此变化。GIKI 组纤溶酶原激活物抑制剂-1显著下降，而对照组显著升高。与其他组相比，GIKI 组低血糖事件更常见。
结论
GIKI 可改善非 ST 段抬高型急性冠状动脉综合征患者的 1 年结局。这种有益作用与血小板反应性降低和纤溶试验增加有关。
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