血糖变异性对急性冠脉综合征患者近期预后的影响

目的 回顾性分析血糖变异性对急性冠脉综合征(ACS)近期预后的相关性.方法 选择878例ACS患者,其中有糖尿病史者298例,无糖病史者580例.将所有患者按住院期间血糖变异性(以血糖变异系数CV为指标)和平均血糖水平按照四分位法分为4组,记录所有患者基线资料、住院期间血糖变异性、平均血糖水平及不良事件发生情况并进行回顾性分析.结果 878例ACS患者,按照血糖变异性以四分位法分为4组,随着血糖变异性增大,住院期间心衰、心源性休克、死亡率增加,组间差异明显(p＜0.001).将有糖尿病史者、无糖尿病史者各自按同样方法分为4组,亦见随血糖变异性增大,住院期间死亡率增加,且组间差异明显(P＜0.05);按平均血糖水平分组时,结果类似.多元回归分析显示患者基线时各指标、住院期间血糖变异性、住院期间平均血糖水平中有5种因素与死亡呈显著相关,依次为糖尿病、高血压、高密度脂蛋白胆固醇、平均血糖、血糖CV.结论 无论是否合并糖尿病,ACS患者住院期间的血糖变异性均与近期预后不良相联系.临床工作中应加强对ACS患者的血糖监测和对血糖稳定性的控制.

Effects of glucose variability on the recent prognosis of acute coronary syndrome

Objective To retrospectively analyze the correlation between the glucose variability and the recent prognosis of acute coronary syndrome.Methods Eight hundred and seventy-eight patients with acute coronary syndrome(ACS)were enrolled in present study,of them 298 cases had history of diabetes mellitus and 580 patients had no history of diabetes mellitus.All ACS patients were divided into 4 groups according to glucose variability blood glucose coefficient of variation(CV)as index] or mean blood glucose during hospitalization.The baseline data,such as characteristics,clinical features,outcome and adverse event,of all patients with ACS were collected,and the mean blood glucose and glucose variability were calculated.Other indices of blood glucose,such as maximum blood glucose concentration during hospitalization(GluMax)and blood glucose concentration on admission(GluAdm)were also collected.The correlations between these variables and hospital mortality were analyzed retrospectively.Results Eighty-two patients died during hospitalization.The incidence of myocardial infarction and cardiogenic shock as well as hospital mortality in the patients with ACS increased significantly along with the elevation of both mean blood glucose and glucose variability during hospitalization(P<0.001).There were positive correlations between blood glucose CV and the mortality in patents with/without diabetes history during hospitalization(P=0.021).Multiple logistic regression analysis revealed that 5 risk factors(including diabetes mellitus,hypertension,HDL-C,mean blood glucose and glucose variability)were independent predictor of mortality.Conclusion The mean blood glucose and glucose variability might be considered as useful additional parameters in the management of these ACS patients,and special attention should be paid on monitoring and controlling the glucose stability of ACS patients.