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《国际心血管病杂志》[ISSN:1006-6977/CN:61-1281/TN]

期数:

2019年03期

页码:

170-175

栏目:

临床研究

出版日期:

2019-05-27

文章信息/Info

Title:

Effects of stress hyperglycemia on the in-hospital and long-term prognosis of patients with acute ST-segment elevation myocardial infarction

作者:

魏显敬 谢莲娜

116001 大连大学附属中山医院循环四科

Author(s):

WEI Xianjing;  XIE Lianna

Department of Cardiology, Affiliated Zhongshan Hospital of Dalian University, Liaoning 116001, China

关键词:

应激性高血糖;  急性ST段抬高型心肌梗死;  院内死亡;  预后

Keywords:

Stress hyperglycemia;  Acute ST-segment elevation myocardial infarction;  In-hospital death;  Prognosis

分类号:

-

DOI:

10.3969/j.issn.1673-6583.2019.03.010

文献标识码:

-

摘要:

目的:探讨应激性高血糖对急性ST段抬高型心肌梗死(STEMI)患者院内死亡、主要不良心脑血管事件(MACCE)及远期预后的影响。方法:连续纳入2015年1月至2017年1月大连大学附属中山医院因STEMI入院的456例患者,根据入院随机血糖分为应激性高血糖组(n=86)和非应激性高血糖组(n=370),记录两组患者的一般资料、既往史、辅助检查结果、用药情况、冠状动脉造影术中情况、院内转归等资料,随访患者1年内 MACCE的发生情况,分析应激性高血糖与院内死亡的相关性及对STEMI患者预后的预测价值。结果:86例患者出现了应激性高血糖(18.9%),其中65例既往有糖尿病史。应激性高血糖组院内死亡率明显高于非应激性高血糖组(14.0%对3.2%,P<0.001),院内恶性心律失常、心源性休克的发生率,置入临时起搏器的比例均高于非应激性高血糖组(P均<0.05)。多因素Cox回归分析显示,应激性高血糖是STEMI患者发生院内死亡的独立危险因素(OR=7.896, 95%CI:4.690～12.243,P=0.012)。应激性高血糖组的1年MACCE发生率明显高于非应激性高血糖发生率(41.7%对26.6%,P=0.011); 将性别、年龄、高血压史、陈旧性心肌梗死病史、应激性高血糖、谷丙转氨酶、左室射血分数纳入Cox回归模型,应激性高血糖是STEMI患者1年内发生MACCE事件的独立危险因素(OR=4.598,95%CI:2.409～8.777,P<0.001)。入院随机血糖预测STEMI患者院内死亡的受试者工作特征曲线的曲线下面积(AUC)为0.733,P=0.002。结论:应激性高血糖是STEMI患者院内死亡的独立危险因素,可预测STEMI患者术后1年内MACCE的发生情况。

Abstract:

Objective:To investigate the effects of stress hyperglycemia on in-hospital death, major adverse cardiovascular or cerebrovascular events(MACCE)and long-term prognosis in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods:Totally 456 patients with STEMI were consecutively enrolled from January 2015 to January 2017 in Zhongshan hospital affiliated to Dalian University. According to random blood glucose level on admission, all the patients were divided into two groups: hyperglycemia group(n=86)and non-hyperglycemia group(n=370). We recorded the baseline data, past medical history, laboratory test and imaging finding, drugs used, coronary angiography data, in-hospital outcome, and MACCE during one-year follow-up to find if there was a correlation between stress hyperglycemia and in-hospital death and evaluate the predictive value of stress hyperglycemia for prognosis.Results:Stress hyperglycemia occurred in 86 patients(18.9%), 65 of whom had a history of diabetes. Compared with non-hyperglycemia group, in hyperglycemia group the in-hospital mortality was significantly higher(14.0% vs. 3.2%, P<0.001), and the incidence of malignant arrhythmia and cardiogenic shock in hospital, as well as the proportion of temporary pacemaker installment were higher(all P<0.05). Multivariate Cox regression analysis showed that stress hyperglycemia was an independent risk factor for in-hospital death in STEMI patients(OR=7.896, 95% CI: 4.690～12.243, P=0.012). The one-year incidence of MACCE was significantly higher in the hyperglycemia group than in the non-hyperglycemia group(41.7% vs. 26.6%, P=0.011). The Cox regression model, which included gender, age, history of hypertension, history of myocardial infarction, stress hyperglycemia, alanine transaminase and left ventricular ejection fraction, revealed that stress hyperglycemia was an independent risk factor for MACCE in patients with STEMI within one-year follow-up(OR=4.598, 95% CI: 2.409～8.777, P<0.001). It was shown by receiver operating characteristic(ROC)curve analysis that the area under the ROC curve(AUC)of random blood glucose level on admission for predicting in-hospital death in ATEMI patients was 0.733(P=0.002).Conclusions:Stress hyperglycemia is an independent risk factor for in-hospital death in STEMI patients, and it has reference value for predicting one-year MACCE.

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备注/Memo

备注/Memo:

通信作者:谢莲娜,Email:xieln1963@163.com

常用功能

更新日期/Last Update: 2019-05-27