急性心肌梗死患者入院时RBC和Hb与住院期间死亡的关系

目的探讨急性心肌梗死（AMI）患者人院时红细胞计数（RBC）和血红蛋白（Hb）水平与住院期间死亡的关系。方法以849例初发AMI住院患者为研究对象,收集入院时人口统计学、血RBC计数和Hb等生化指标,收集住院期间死亡资料,采用单因素和多因素分析方法,分析入院时血RBC计数和Hb水平与住院期间死亡的关联关系。结果死亡病例的入院RBC计数和HB水平显著高于存活病例。经单因素Logistic回归分析,RBC计数与住院期间死亡呈显著的关联关系（P〈0．01）,但经多因素分析后,这种关联变得无统计学意义。经单因素分析,与Hb120-140g／L组相比,Hb〈100g／L组住院期间发生死亡的危险性为2．716,但经多因素分析后,其OR值无统计学意义。结论人院时血RBC计数和Hb水平可能不是AMI住院患者死亡的重要预示指标。     

血清C反应蛋白对急性心肌梗死的预后价值

目的：观察血清C-反应蛋白（CRP）水平与急性心肌梗死（AMI）患者6个月时心功能及病死率的关系。方法：入选我院572例AMI住院患者,根据入院时CRP水平分为CRP升高组及CRP正常组,随访6个月,记录超声心动图结果及死亡例数。结果：两组基线资料无明显差异。与入院时CRP正常组比较,CRP升高组患者6个月时LVEDD、LVESD,住院期间及随访期间病死率显著增加,而6个月时LVEF显著降低（P〈0.05）。多因素分析结果显示入院时CRP升高是AMI患者住院期间及6个月病死率的独立危险因素。结论：血清CRP升高是AMI患者心功能及病死率的预测因素,关注AMI患者血清CRP水平,尽早开始控制,有利于改善AMI的预后。     

老年动脉硬化性脑梗死患者白细胞计数与肌钙蛋白 I水平的关系研究

目的：通过检测老年动脉硬化性脑梗死患者外周血白细胞（WBC）计数及心肌肌钙蛋白I（cTnI）,探讨WBC计数评价老年动脉硬化性脑梗死患者心功能的临床意义。方法200例老年动脉硬化性脑梗死患者经查血常规后,分为WBC计数正常组和WBC计数增高组,测定其cTnI与血肌酸激酶MB型同工酶（CK-MB）,并于住院1周时行超声心动图检查。结果WBC计数增高组cTnI及CK-MB水平均明显高于WBC计数正常组（t＝7．506、10．420,P＜0．01）;WBC计数增高组的窦性心动过速、房室传导阻滞、心房纤颤、室性早搏的发生率明显高于WBC计数正常组（χ2＝4．379、5．563、8．431、11．525,P＜0．05）;WBC计数增高组射血分数（EF）、左室短轴缩短率（FS）均明显低于WBC计数正常组（t＝2．927、2．378,P＜0．05）,而左室收缩末期容积（LVESV）、左室舒张末期容积（LVEDV）明显高于WBC计数正常组（t＝2．786、3．404,P＜0．05）。结论WBC计数升高的老年动脉硬化性脑梗死患者,其体内代表心肌损伤和坏死的标记物cTnI及CK-MB也随之升高,炎性反应和心肌损伤加重,恶性心律失常发生率升高。     

急性心肌梗塞的预后与白细胞计数及左心室射血分数关系探讨

目的探讨白细胞计数(WBC)及左室射血分数(LVEF)与急性心肌梗塞(AMI)的预后的关系。方法观察了58例年龄≤75岁确诊AMI病人。所有病人均作WBC计数检测,48例进行了LVEF测定。结果 WBC计数升高(>10．0×109／L)的 AMI病人30天病死率高于WBC正常者(P=0．037);WBC升高的AMI病人其LVEF呈下降趋势;LVEF≤50％,且WBC>10． 0×109／L的AMI病人(13例)30天病死率显著高于LVEF>50％的病人。结论 WBC升高与AMI后低LVEF是影响30天病死率的高度危险因素。     

对应导联ST段压低急性心肌梗死85例临床分析

目的探讨伴对应导联ST段压低型急性心肌梗死（AMI）的早期（4周内）心功能（Killip分级）、死亡率及死亡原因。方法2001年1月～2005年12月住院,首次ST段抬高型AMI患者177例,前壁与下壁互为对应导联,以相邻2个或2个以上对应导联水平型或下斜型ST段压低≥0．1mV为标准,分为ST段压低组（观察组）85例、及非ST段压低组（对照组）92例。结果对应导联压低组AMI引起的心力衰竭（泵衰竭）及心功能KillipⅢ～Ⅳ级死亡病例明显高于不伴有对应导联ST段压低组（P〈0．05）,同时泵衰竭是AMI死亡的主要原因。结论对应导联ST段压低型急性心肌梗死,这种心电变化并非生理性改变,而是心肌梗死面积扩大的表现,应早期实施冠脉再通,保护心功能,降低死亡率。     

无保护左主干病变导致急性心肌梗死合并心源性休克的临床分析北大核心CSCD

目的分析无保护左主干（ULMCA）病变导致急性心肌梗死（AMI）合并心源性休克（CS）患者的临床表现和近、远期预后。方法从1999年1月至2014年5月,共完成5798例急诊冠状动脉造影,入选经急诊造影证实梗死相关血管（IRA）为ULMCA的AMI患者。根据住院期间是否存在CS将患者分为休克组和对照组,收集入选患者的临床资料、造影及介入治疗资料。比较两组患者的临床情况和近、远期临床随访结果。分析ULMCA病变导致AMI患者合并CS的临床特点,以及合并CS对该类患者近、远期临床预后的影响。结果最终有58例ULMCA病变所致AMI患者纳入研究,其中31例患者（53．4％）存在CS。与对照组比较,CS组患者术前侧支循环2—3级的比率、最终的TIMI血流3级比率和左室射血分数较低。Logistic回归分析则提示仅有较低的术前侧支循环2-3级是住院期间发生CS的预测因素（OR=0．19,P=n02）。住院期间一共死亡23例（39．7％）,其中休克组住院病死率明显高于对照组（64．5％郴．11．1％,P〈0．01）。Logistic回归分析提示CS是住院期间死亡的预测因素（OR：6．94,P=0．01）。35例患者存活出院,完成中位数42．0个月（12．0,60．0）的随访。Kaplan—Meier分析估算无休克患者的总累计生存率为51．8％,而休克患者的总累计生存率仅为20．3％（Log—rank,P〈0．01）。COX多因素回归分析显示,住院期间存在CS则是ULMCA病变所致AMI患者总病死率的唯一预测因素（HR=4．67,P=0．004）。结论ULMCA病变所致的AMI患者病情凶险,CS发生率高,CS与该类患者近、远期病死率相关。     

非糖尿病性持续性高血糖与一过性高血糖对急性心肌梗死患者预后的影响

【目的】探讨非糖尿病性持续性高血糖对急性心肌梗死（AMI）患者预后影响。【方法】将2010年8月至2012年8月本院收治的125例A M I住院患者排除糖尿病后,根据住院期间患者随机血糖值分为：A组（入院24 h后空腹血糖＜6．1 mmol/L ）;B 组（入院24 h 后空腹血糖＜6．1 mmol/L 且随机血糖＜9．0 mmol/L ）;C组（入院24 h后空腹血糖≥6．1 mmol/L或随机血糖≥9．0 mmol/L ）。分析比较各组恶性心律失常、心力衰竭、死亡的发生率。【结果】C组恶性心律失常、心力衰竭、死亡发生率均高于A组、B组,且差异有显著性（P ＜0．05）。B组恶性心律失常及心力衰竭的发生率均高于A组,且差异有显著性（P ＜0．05）,A组与B组死亡的发生率相比较差异无显著性（ P＞0．05）。【结论】非糖尿病性持续性高血糖AMI患者的预后较一过性高血糖患者的预后差,检测其血糖水平对判断此类患者的预后具有一定的临床意义。     

急性冠脉综合征的抗炎治疗

据世界卫生组织统计，冠心病是世界上最常见的死亡原因，其中急性冠脉综合征（ACS）患者占冠心病住院患者的绝大部分。在过去的20年里，随着药物治疗以及机械血运重建技术的进展，急诊经皮冠状动脉（冠脉）成形术和急诊冠脉旁路移植术的发展，心脏病加强治疗病房的建立和完善，使得急性心肌梗死（AMI）合并心源性休克（CS）患者的住院病死率显著下降。最近的SHOCK研究发现，部分AMI合并CS患者美国纽约心脏协会（NYHA）心功能分级Ⅰ级，其平均射血分数（EF）值是0．30.     

CRP、WBC及N%的联合检测在老年细菌性感染疾病中的应用

目的探讨CRP（C-反应蛋白）、WBC（白细胞）、N%（中性粒细胞比率）联合检测在老年细菌性感染疾病中的临床应用价值。方法 150例已确诊为细菌性感染疾病的老年病人,入院时及用抗生素治疗4d后进行CRP测定、WBC计数及分类。结果有127例病人CRP阳性（≥20mg/L）,占85%,WBC计数增高（10.0～30.0×109/L）有93人,占62%,中性粒细胞比率增高（〉70%）有109人,占73%。CRP、WBC计数及N%联合检测敏感率达95%。抗生素有效治疗前后CPR测定值有显著差异（P〈0.01）,随病情好转而逐步下降。结论 CPP、WBC、N%的联合检测可提高老年人细菌性感染诊断的敏感性,CRP测定在实验诊断上的敏感性高于WBC、N%。     

外周血白细胞计数对急性心肌梗死心力衰竭的预测作用

目的　了解急性心肌梗死 (AMI)患者入院时外周血白细胞 (WBC)及中性粒细胞 (NER)计数是否与住院期心衰和死亡事件以及随访期的死亡事件有相关性。方法　对 2 0 0 0年 1月 1日～ 2 0 0 1年 12月 31日收治的因AMI住进冠心病监护病房的 12 3例患者于入院时立即取外周血查血常规 ,并连续观察其住院期和随访期的临床结果 ,分析WBC和NER与心衰及死亡事件的相关性及预测价值。结果　心衰组患者WBC计数 (P =0 0 0 3)及NER绝对值 (P =0 0 0 4 )明显高于非心衰组患者 ,而NER %两组间无显著差异 (P =0 0 94 ) ,WBC计数 (r =0 314 ,P <0 0 0 1)及NER绝对值 (r =0 2 6 1,P =0 0 0 4 )与心衰的发生呈正相关 ,而NER %与心衰发生无明显相关性 (r =0 14 9,P =0 10 0 )。WBC计数 >11 0× 10 9/L(χ2 =4 0 0 7,P =0 0 31,OR =0 2 35 ,CI=0 0 5 8～ 0 95 8)以及NER绝对值 >12 0× 10 9/L(χ2 =4 6 14 ,P =0 0 32 ,OR =2 36 1,CI=0 4 6 9～ 11 895 )为心衰的独立预测因素。住院期和随访期死亡组WBC、NER、NER %均大于非死亡组 ,但差别无统计学意义。结论　本研究证明 ,AMI发病后 6h内WBC和NER增加与住院期心力衰竭发生有关 ,是相对简单易行的预测AMI发生心衰的指标 ,NER绝对值较NER %敏感性高。同时提醒人     

基础白细胞计数增高的急性心肌梗死患者冠状动脉介入术后冠状动脉血流储备降低对远期预后的影响

目的急性心肌梗死(AMI)患者在接受了冠状动脉介入术(PCI)后,即刻冠状动脉血流储备(CFR)的降低,以及AMI急性期基础血液中白细胞计数的增加均被视为AMI患者远期预后不良的预测因子。我们现将这两项指标联合起来评价AMI患者的远期预后。方法选自2010年8月至2012年6月在医院就诊的AMI患者共72例,所有患者在发病24 h内接受了急诊PCI治疗,并于术后即刻应用经冠状动脉多普勒导丝测量的CFR。基础血白细胞计数以患者发病24 h内化验取得,并满足白细胞计数≥10.0×109/L。所有患者均进行了临床随访,平均随访时间(12.7±7.1)个月,以观察主要不良心脏事件(MACE)。根据MACE与CFR的关系,应用ROC曲线获得相关阈值,将患者分为2组进行对照分析,第一组:CFR<1.4;第二组:CFR≥1.4。结果第一组患者的基础血CK及CK-MB明显高于第二组患者,分别为(4 109±407)U/L vs.(2 685±562)U/L,P<0.05及(290.8±26.6)ng/ml vs.(255.7±65.6)ng/ml,P<0.05。第一组患者PCI术后即刻MBG3级占比明显低于第二组患者(25.9%vs.38.9%,P<0.05)。随访期间第一组患者的MACE明显高于第二组(40.7%vs.27.8%,P<0.05),主要体现在总死亡率的增高上(13.0%vs.0,P<0.05)。结论对于基础血白细胞计数增高的AMI患者,接受急诊PCI治疗后CFR<1.4是预示患者远期预后不良的重要因素,这部分患者的总死亡率明显高于CRF≥1.4的患者。这一结果进一步阐明了微血管功能及炎症反应与AMI患者的远期预后的关系。     

糖尿病在急性心肌梗死危险评估中地位的探讨

目的 观察血糖升高对急性心肌梗死(AMI)患者预后的影响,探讨糖尿病在AMI危险评估中的地位.方法 回顾性选择解放军第八一医院2000年1月至2010年5月收治的AMI患者.将无糖尿病史、空腹血糖(FBG)≥7.0 mmol/L,而后又恢复正常定义为非糖尿病AMI患者的应激性高血糖.根据FBG水平将糖尿病和非糖尿病患者分为<7.0、7.0～7.9、8.0～11.0及≥11.1 mmol/L 4组,观察院内病死率、并发症发生率及降糖治疗情况;并对AMI预后危险因素进行Logistic回归分析.结果 共入选AMI患者152例,糖尿病组45例,其中FBG≥8.0 mmol/L者占73.3%(33例),FBG≥11.1 mmol/L者占46.7%(21例);非糖尿病组107例,发生应激性高血糖者(47例,占43.9%)中有91.5%的患者(43例)FBG为7.0～11.0 mmol/L.糖尿病组院内病死率较非糖尿病组显著增高(35.6%比15.9%,P=0.007),且两组病死率均随FBG升高呈上升趋势.多因素Logistic回归分析显示,FBG≥8.0 mmol/L糖尿病患者死亡风险是FBG<8.0 mmol/L者的12.28倍,FBG≥7.0 mmol/L非糖尿病患者死亡风险是FBG<7.0 mmol/L者的4.81倍.FBG是AMI死亡的独立危险因素,糖尿病组相对比值比(OR)为1.03,95%可信区间(95%CI)为1.01～1.16,P=0.012;非糖尿病组OR为1.56,95%CI为1.09～2.23,P=0.015.糖尿病组充血性心力衰竭发生率较非糖尿病组显著增高(40.0H比22.4%,P=0.027);其中非糖尿病组FBG≥7.0 mmol/L者肺部感染、充血性心力衰竭、严重心律失常及急性脑血管事件发生率(分别为51.1%、34.0%、27.7%、14.9%)均较FBG<7.0 mmol/L者(分别为18.3%、13.3%、10.0%、0)显著增高(P<0.05或P<0.01),而在糖尿病组中未观察到该现象.糖尿病组中有80.0%(36例)的患者接受降糖治疗,其中23例(占63.9%)应用胰岛素;而非糖尿病组应激性高血糖者无一例进行降血糖治疗.结论 糖尿病AMI患者及伴应激性高血糖的非糖尿病AMI患者院内病死率和并发症发生率增加,糖尿病史和血糖都是影响AMI预后的危险因素,将二者结合起来对AMI进行危险分层更为合理.

Abstract：

Objective To determine the impact of elevated in-hospital glucose level on outcome of patients with acute myocardial infarction (AMI),and evaluate the role of diabetes mellitus as a risk factor of AMI.Methods The study included a retrospective analysis of AMI patients who were admitted to No.81 Hospital of PLA from January 2000 to May 2010.In patients without a history of diabetes,and those with fasting blood glucose(FBG)≥7.0 mmol/L at admission but returned to normal range soon after admission were defined as stress hyperglycemia of non-diabetic AMI patients.Both diabetic patients and non-diabetic patients were stratified into four mutually exclusive groups according to FBG levels:<7.0,7.0-7.9,8.0-11.0 and≥11.1 mmol/L.The in-hospital mortality,incidence of complications,and treatment to lower glucose level were analyzed.Logistic regression analysis was conducted on risk factors of outcome of AMI patients.Results One hundred and fifty-two AMI patients were enrolled with 45 diabetic patients and 107 patients without previous diabetes.In diabetic group patients with FBG≥8.0 mmol/L and those with FBG≥11.1 mmol/L accounted for 73.3%(33 cases)and 46.7%(21 cases),respectively.In non-diabetic group patients with stress hyperglycemia accounted for 43.9%(47 cases),among which patients with FBG levels of 7.0-11.0 mmol/L accounted for 91.5%(43 cases).Compared with the non-diabetic group,the in-hospital mortality was significantly higher in diabetic group(35.6%vs.1 5.9%,P=0.007).In both groups,the in-hospital mortality presented an elevating tendency with an increasing FBG level.Multivariate Logistic regression analysis demonstrated that in diabetic group patients with FBG≥8.0 mmol/L had 12.28-fold higher risk of death than patients with FBG<8.0 mmol/L,and that in non-diabetic group patients with FBG≥7.0 mmol/L had 4.81-fold higher risk of death than patients with FBG<7.0 mmol/L.FBG was an independent risk factor of death with relative odds ratio(OR)1.03,with 95% confidence interval(95% CI)1.01-1.16,P=0.012,and OR 1.56,95% CI 1.09-2.23,P=0.015 in diabetic group and non-diabetic group,respectively.The incidence of congestive heart failure in diabetic group was significantly higher than that in non-diabetic group (40.0% vs.22.4%,P=0.027).In non-diabetic group,the incidence of lung infection,congestive heart failure,serious arrhythmias and acute cerebrovascular events(51.1%,34.0%,27.7%,14.9%,respectively) was increased significantly in patients with FBG≥7.0 mmol/L than that in patients with FBG<7.0mmol/L(18.3%,13.3%,10.0%,0,respectively,P<0.05 or P<0.01).This association was not seen in diabetic group.80.0%of patients(36 cases)in diabetic group received anti-hyperglycemia treatments in which insulin therapy accounted for 63.9%(23 cases),while there was not even 1 patient who needed insulin therapy in non-diabetic patients with stress hyperglycemia.Conclusion In-hospital mortality and complications were significantly increased in diabetic AMI patients and in non-diabetic AMI patients with stress hyperglycemia.Both a history of diabetes mellitus and stress hyperglycemia have strong influence on AMI prognosis.It seems to be more plausible to collaborate blood glucose level with history of diabetes in considering risk factors in AMI patients.     

The Association between White Blood Cell Count and Acute Myocardial Infarction In-hospital Mortality: Findings from the National Registry of Myocardial Infarction

OBJECTIVES: Although cross-sectional and prospective studies have shown that the white blood cell (WBC) count is associated with long-term mortality for patients with ischemic heart disease, the role of the WBC count as an independent predictor of short-term mortality in patients with acute myocardial infarction (AMI) has not been examined as extensively. The objective of this study was to determine whether the WBC count is associated with in-hospital mortality for patients with ischemic heart disease after controlling for potential confounders. METHODS: From July 31, 2000, to July 31, 2001, the National Registry of Myocardial Infarction 4 enrolled 186,727 AMI patients. A total of 115,273 patients were included in the analysis. RESULTS: WBC counts were subdivided into intervals of 1,000/mL, and in-hospital mortality rates were determined for each interval. The distribution revealed a J-shaped curve. Patients with WBC counts >5,000/mL were subdivided into quartiles, whereas patients with WBC counts <5,000/mL were assigned to a separate category labeled "subquartile" and were analyzed separately. A linear increase in in-hospital mortality by WBC count quartile was found. The unadjusted odds ratio (OR) for the fourth versus the first quartile showed strong associations with in-hospital mortality among the entire population and by gender: 4.09 (95% confidence interval [95% CI] = 3.83 to 4.73) for all patients, 4.31 (95% CI = 3.93 to 4.73) for men, and 3.65 (95% CI = 3.32 to 4.01) for women. Following adjustment for covariates, the magnitude of the ORs attenuated, but the ORs remained highly significant (OR, 2.71 [95% CI = 2.53 to 2.90] for all patients; OR, 2.87 [95% CI = 2.59 to 3.19] for men; OR, 2.61 [95% CI = 2.36 to 2.99] for women). Reperfused patients had consistently lower in-hospital mortality rates for all patients and by gender (p < 0.0001). CONCLUSIONS: The WBC count is an independent predictor of in-hospital AMI mortality and may be useful in assessing the prognosis of AMI in conjunction with other early risk-stratification factors. Whether elevated WBC count is a marker of the inflammatory process or is a direct risk factor for AMI remains unclear. Given the simplicity and availability of the WBC count, the authors conclude that the WBC count should be used in conjunction with other ancillary tests to assess the prognosis of a patient with AMI.     

急性心肌梗死急诊PCI支架术后无复流现象的临床分析

目的 研究对急性心肌梗死(AMI)患者行急诊经皮冠状动脉介入(PCI)时无复流的发生率及其死亡率,评估其影响因素.方法 将169名AMI行急诊PCI支架术的患者,分成无复流组和血流正常组,评估无复流现象的发生率,住院期间死亡率及各项临床指标对无复流的意义.结果 两组在平均年龄、性别、合并糖尿病、高血压、高脂血症、吸烟、心梗部位等方面没有显著差异,但在缺乏梗死前心绞痛史、冠脉开通时间,入院时心功能分级(Killip分级)、入院时白细胞计数、肌酸磷酸激酶同工酶(CK-MB)、肌钙蛋白Ⅰ(cTnI)及住院期间死亡率等方面具有显著差异.无复流的发生率17.2%.结论 无梗死前心绞痛史、冠脉开通时间长、入院时心功能分级低、白细胞计数高、CK-MB与cTnI水平高等是无复流现象发生的独立的危险因素,PCI后出现无复流现象提示预后不良.     

急性心肌梗死患者入院血糖水平与经皮冠状动脉介入治疗后预后的关系

目的 观察急性心肌梗死 (AMI) 患者随机血糖水平对介入治疗后预后的影响.方法 选取急性心肌梗死患者354例,根据入院第一次随机血糖分为3组:A组:132例,血糖＜7.80 mmol/L;B组120例,血糖7.80～11.00 mmol/L;C组102例,血糖≥11.00 mmol/L.结果 与A组相比,C组血胆固醇、低密度脂蛋白、甘油三酯浓度较高(P<0.05).冠状动脉造影示B、C组多支病变比例高于A组,但差异无统计学意义(P>0.05).B、C组校正TIMI帧数(CTFC)值高于A组(P<0.05).B、C组主要心血管事件发生率及病死率高于A组,其中C组与A组相比差异有统计学意义(P<0.05).结论 入院随机血糖升高的急性心肌梗死患者,进行直接介入治疗后预后较差,心血管事件发生率及病死率较高.     

应激性高血糖对非糖尿病急性心肌梗死预后的影响

目的 急性心肌梗死(acute myocardial infarction,AMI)常见血糖升高,其增高的程度与疾病转归相关.现以空腹血糖定义非糖尿病AMI患者的应激性高血糖,研究应激性高血糖对非糖尿病的AMI院内预后的影响.方法 研究对象为南京解放军第81医院2000年1月至2010年5月收治入院的107例非糖尿病AMI患者.回顾性分析各组的院内死亡和院内并发症.排除标准:(1)年龄小于18岁;(2)有糖尿病史;(3)无糖尿病史但住院期间启动降糖治疗的患者;(4)非心血管病因的急性心肌梗死患者;(5)严重肝肾功能不全、严重肺部基础疾患、恶性肿瘤晚期患者;(6)近期使用过类同醇药物以及甲状腺机能亢进、库欣综合征等影响葡萄糖代谢疾病的患者.根据空腹血糖(fastingblood glucose,FBG)水平将其分为4组,分别是:<7.0 mmol/L,7.0～8.0 mmol/L,8.0～11.1 mmol/L,≥11.1 mmoL/L.采用Stata 9.2统计软件,分别进行成组t检验、方差分析、秩和检验及确切概率法分析.对有意义的变量进行多因素logistics回归分析.结果 发生应激性高血糖47例(43.9%).FBG≥7.0 mmol/L的患者即有应激性高血糖的患者较FBG<7.0 mmol/L患者的病死率显著增高,分别是27.66%和6.67%(P=0.006 3),OR=5.35(95%CI 1.61～17.75,P=0.006 1),肺部感染、充血性心力衰竭、严重心律失常和急性脑血管事件等院内并发症发生率也显著增高.经多因素Logistic回归分析显示FBG是AMI死亡的独立危险因素,OR=1.56(95%CI 1.09～2.23).结论 有应激性高血糖的非糖尿病AMI患者死亡风险增高、院内并发症显著增多.应激性高血糖可作为判定非糖尿病AMI预后的一个较好指标.

Abstract：

Objective Hyperglycemia was common during acute myocardiai infarction (AMI). This study investigated the impact of stress hyperglycemia on in-hospital outcomes in patients without diabetes hospitalized with AMI. Methods The study included 107 patients with AMI without diabetes, who were admitted to 81 hospital of PLA of Nanjing, China from January 2000 to May 2010. The in-hospital mortality and in-hospital complications were analyzed retrospectively. The exclusion criteria were: (1 ) patients < 18 years old; (2) patients with history of diabetes; (3) patients who initiated anti-hyperglycemic therapy during their hospital stay though without previously diagnosed diabetes; (4) patients with non-cardiovascular causes for AMI; (5) patients with hepatic failure, kidney failure, serious lung illnesses and end stage of malignant tumour; (6) patients administrated with steroid treatment recently and those with some diseases which had dramatic effect on glucose metabolism such as hyperthyroidism and cushing syndrome. Patients were categorized according to FBG levels into4 mutually exclusive groups; <7.0 mmol/L, ≥7.0 but <8.0 mmol/L, 8.0 to< 11. 1 mmol/L and ≥11.1 mmol/L. The Statistical Package for Stata, version 9.2 was used for statistical analysis. According to corresponding data analysis of /-test, ANOVA, rank test and exact propability were used respectively. Univariate logistics regression analysis was conducted followed by multivariate logistics regression analysis on significant variables. Results The incidence rate of stress hyperglycemia in patients with AMI without diabetes was 43. 9% (n =47). In non-diabetic patients, the mortality of the group of FBG≥7. 0 mmol/L was significantly higher than the group of FBG < 7. 0 mmol/L, which are 27.66% and 6.67%(P=0.0063)respectively,OR=5.35(95%CI 1.61 - 17.75,P = 0.0061). In-hospital complications for example lung infection, congestive heart failure, serious arrhythmias and acute cerebrovas-cular events were increased significantly in AMI patients with stress hyperglycemia. Multivariate logistic regression analysis for mortality were performed adjusting for risk factors which demonstrated FBG was a independent risk factors of in-hospital death , OR = 1.56(95%CIl.09 -2.23). Conclusions In-hospital mortality and in-hospital complications were significantly increased in patients with AMI without diabetes which developed stress hyperglycemia. Stress hyperglycemia was of great prognostic value for short-outcomes of AMI.     

老年急性心肌梗死患者住院死亡危险因素分析

目的探讨入院时影响老年急性心肌梗死(AMI)患者住院病死率的危险因素。方法选取因AMI收住的356例老年患者为研究对象。分析病死组(45例)与存活组(311例)患者的临床特征、实验室化验指标、心血管并发症(心源性休克、心力衰竭、室速/室颤),以Logistic多因素逐步回归分析影响老年AMI患者住院病死率的相关因素。结果单因素分析显示:年龄、糖尿病史、陈旧性MI病史、脑卒中病史、肾功能不全、贫血、首发症状呼吸困难、并发心源性休克、心力衰竭、室速/室颤,入院时血清肌酐升高、肾小球滤过率(eGFR)及血红蛋白减低、肌酸激酶及其同工酶峰值水平与老年AMI患者住院病死率相关(均P0.05)。多因素分析显示:年龄、糖尿病史、陈旧性MI病史,并发心源性休克、心力衰竭、室速/室颤,入院时eGFR水平是影响老年AMI患者住院病死率的独立危险因素(均P0.05)。结论年龄、糖尿病及陈旧性MI病史、发生心血管并发症、入院时eGFR水平是影响老年AMI患者住院病死率的独立危险因素。     

The white blood cell count is an independent predictor of no-reflow and mortality following acute myocardial infarction in the coronary interventional era

BACKGROUND: In the era before the use of coronary reperfusion therapy, an elevated white blood cell (WBC) count was associated with a higher risk of adverse events following acute myocardial infarction (AMI). However, the relationship between WBC count and prognosis after AMI has not been investigated since coronary intervention was introduced. AIM: To evaluate whether a high WBC count within 48 hours of the onset of AMI predicts future adverse events in patients undergoing percutaneous coronary intervention (PCI). METHOD: We evaluated 1,016 patients who underwent PCI in the acute phase of MI using the Japanese Acute Coronary Syndrome Study (JACSS) database. RESULTS. WBC count was significantly associated with smoking, sudden onset AMI, and the no-reflow phenomenon during PCI, as were age, peak creatine kinase level, and Killip class. An elevated WBC count was significantly associated with higher risk of in-hospital mortality. Patients in the highest quartile of WBC count were about three times more likely to have a poor prognosis after AMI compared to those in the lowest quartile. CONCLUSIONS: The WBC count is of great significance for stratifying patient risk and can be used as a universal marker for predicting future adverse events following any treatment for AMI.     

中性粒细胞计数对急性心肌梗死患者早期充血性心力衰竭的预测价值

目的探讨中性粒细胞绝对值的升高对前壁急性心肌梗死（AMI）患者早期充血性心力衰竭（CHF）的预测价值。方法回顾性分析我院诊断为前壁AMI 150例患者的临床资料,记录入院第2天清晨白细胞分类计数与入院后超声心动图。采用二分类logistic回归分析中性粒细胞计数与CHF发生率的关系。结果150例中58例（38.7％）出现新发的CHF[左心室射血分数（LVEF）〈40％],其中46例（79.3％）出现中性粒细胞升高（〉7.0×10^9／L）;86例（57.3％）有中性粒细胞升高,其中46例（53.5％）出现CHF症状;中性粒细胞计数与LVEF之间存在负相关（r=-0.437,P=0.000）。结论急性前壁AMI后中性粒细胞计数与LVEF之间存在明显负相关,是AMI早期发生CHF的预测因子。