平均空腹血糖对ST段抬高型心肌梗死患者住院预后的影响

目的 评价平均空腹血糖对ST段抬高型心肌梗死(STEMI)患者住院顶后的影响.方法 对357例发病3 d内入院的无糖尿病史的STEMI患者进行回顾性分析,依据入院后72 h内平均空腹血糖水平分为＜5.6、5.6～7.0和＞7.0 mmol/L 三组.比较其临床特征、住院治疗经过和主要心脏事件及死亡的发生率,通过受试者工作特征(ROC)曲线评估平均空腹血糖对住院死亡的预测价值.结果 平均空腹血糖＜5.6、5.6～7.0和＞7.0 mmol/L的三组患者分别为165、122和70例,其广泛前壁心肌梗死的比例分别占18.2%、29.5%和45.7%(P＜0.05.各组患者在年龄、既往梗死史及溶栓或经皮冠状动脉介入治疗等差异无统计学意义(P＞0.05).入院时心率、白细胞计数、CK-MB峰值随着平均空腹血糖升高而增加(P＜0.05).随着血糖升高,左心室射血分数降低,心力衰竭、恶性心律失常发生率及住院病死率明显增加(P＜0.05).多因素分析显示入院72 h内平均空腹血糖是住院病死率的独立危险因素(OR=1.31,95%CI:1.10～1.57;P=0.003),其顶测住院死亡ROC曲线下面积为0.758(P＜0.001),而单次入院随机血糖、空腹血糖预测住院死亡的ROC曲线下面积分别为0.674和0.717.结论 入院72 h内平均空腹血糖是STEMI住院患者死亡的独立危险因素,其预测价值高于单次的入院随机血糖或空腹血糖.

Impact of mean fasting glucose over the first 72 hours on in-hospital outcomes of patients with ST-segment elevation myocardial infarction

Objective To evaluate the impact of mean fasting glucose over the first 72 hours after admission on in-hospital outcomes in patients with ST-segment elevation myocardial infarction ( STEMI ).Methods The data of 357 non-diabetic patients hospitalized with STEMI were collected from the database of Sun Yat-sen Memorial Hospital, affiliated to Sun Yat-sen University between January 2006 and April 2009.The patients were categorized into 3 groups according to mean fasting glucose over the first 72 hours after admission: ＜ 5.6 ( n = 165 ), 5.6 - 7.0 ( n = 122 ) and ＞ 7.0 mmol/L ( n = 70). Clinical characteristics,therapeutic approaches and the incidence of heart failure, malignant arrhythmias, and death during hospitalization were compared among groups. Multivariate logistic regression analysis was performed to determine the association between risk factors and in-hospital outcomes. Receiver-operator characteristic (ROC) curve was generated to assess the power of mean fasting glucose on predicting in-hospital death. Results Age, past history of infarction and early revascularization therapy were similar among groups. Heart rate on admission, white blood cell count, peak CK-MB level, and proportion of extensive anterior infarction were increased in proportion to higher mean fasting glucose levels. Higher mean fasting glucose levels were associated with increased risk of reduced left ventricular ejection fraction, heart failure characterized by higher Killip class, and malignant arrhythmias. After multivariate adjustment, mean fasting glucose remained to be an independent risk factor for increased in-hospital death of patients with STEMI (OR = 1.31, 95% CI: 1.10 - 1. 57;P =0. 003). Mean fasting glucose had the higher area under the ROC curve than admission glucose or fasting glucose after admission based on single measurement (0. 758, 0. 674and 0. 717;P ＜ 0. 001 ). Conclusion Mean fasting glucose during first 72 hours after admission is an independent predictor for in-hospital death and complications in patients with STEMI, which is superior to admission glucose or fasting glucose after admission based on single measurement in predicting in-hospital outcomes.