急性ST段抬高心肌梗死合并糖代谢异常患者的临床特征和预后分析

目的了解急性ST段抬高心肌梗死合并糖代谢异常患者的临床特征和预后情况。方法选择2010年1月～2011年10月在我院住院的235例急性ST段抬高心肌梗死患者为研究对象,无明确糖尿病史的患者在出院前常规行口服葡萄糖耐量试验（OGTT）,根据糖代谢状况分为糖代谢正常（NGT）组、糖调节受损（IGR）组和糖尿病（DM）组,收集所有患者的生化指标、心脏彩超及冠脉造影等资料,比较上述指标在不同糖代谢患者之间的差异。同时对上述患者进行随访,观察心绞痛、再发心肌梗死、心衰和心源性死亡的发生情况。结果急性心肌梗死合并糖尿病患者中女性较多,入院时心率、血糖、糖化血红蛋白、甘油三酯较高,梗死面积较大,心功能较差,冠脉三支病变比例较高,预后较差。糖调节受损患者甘油三酯水平和心力衰竭发生率也高于糖代谢正常心肌梗死患者,而其他指标两者之间无明显差异。结论急性心肌梗死合并糖代谢异常患者病情较重,预后较差。

Analysis of clinical characteristics and prognosis in patients with acute ST elevation myocardial infarction and abnormalglucose metabolism

Objective To understand the clinical characteristics and prognosis in patients with acute ST elevation my- ocardial infarction and abnormal glucose metabolism. Methods 235 inpatients with acute ST elevation myocardial infarction were consecutively recruited from Jan 2010 to Oct 2011. The patients without previously known diabetes mellitus（DM） were per- formed oral glucose tolerance test （OGTT） to characterize the glucose metabolism status before discharge. All the patients were divided into three groups： normal glucose tolerance （NGT）, impaired glucose regulation （IGR） and diabetes mellitus （DM） based on the history of DM or result of OGTY. The information included admission glucose, glycosylated hemoglobin, Creatine Kinase isoenzyme, Troponin I, blood fat, ultrasound cardiogram and coronary artery angiography were collected. The differences were compared within the indexes of the three groups. All the patients were followed up. The occurrences of angina pectoris, myocar- dial infarction, congestive heart failure and cardiac death were observed. Results There were more female in the AMI with DM. Heart rate, glucose, glycosylated hemoglobin and triglyeeride on admission were higher in the AMI with DM than that without DM. Infarct sizes were larger, heart functions were worse, percentage of three vessels lesions were higher, the prognosis were poor in the AMI with DM. The level of triglyceride and incidence of heart failure were higher in the patients with IGR than that with NGT. Conclusion The clinical condition is severe and the prognosis is bad in the patients of acute myocardial in- farction with abnormal glucose metabolism.