应激性高血糖与老年急诊冠状动脉介入术后心肌灌注及临床预后的相关性

目的分析应激性高血糖（SHG）对行急诊经皮冠状动脉介入术（PCI）老年患者心肌灌注情况影响及与预后的相关性。方法选择首次急性ST段抬高心肌梗死（STEMI）且于12 小时内成功实施急诊PCI老年非糖尿病患者459例，依据入院即刻血糖值分为正常组（血糖＜7.0 mmol/L，148例）、升高组（7.0 mmol/L≤血糖≤11.1 mmol/L，169例）、高糖组（血糖＞11.1 mmol/L，142例）。对比各组术后心功能指标、心肌灌注情况，术后随访12个月，记录各组不良心脏事件（MACE）情况。结果正常组、升高组、高糖组心肌灌注血流分级（TMPG） 2～3级的比例、术后2 小时ST段回落良好的比例及左心室射血分数均逐渐下降，而肌酸激酶同工酶的峰值逐渐升高（均P＜0.05）。随访12个月，高糖组无MACE的生存率76.1％（108/142），较正常组89.2％（132/148）、升高组85.8％（145/169）降低，差异有统计学意义（P＜0.05）；经多因素Cox回归分析提示，SHG也是老年STEMI患者PCI术后发生MACE的一个独立预测因素。结论SHG可导致老年STEMI患者行急诊PCI后心肌灌注下降，同时也可使MACE的发生率增高。

Effect of stress induced hyperglycemia on myocardial perfusion and prognosis in elderly patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

Objective To investigate the effect of stress induced hyperglycemia（SHG）on myocardial perfusion and clinical prognosis in elderly patients with acute myocardial infarction（AMI） who underwent primary percutaneous coronary intervention（PCI）. Methods A total of 459 elderly patients with first time occurrence of acute ST elevation myocardial infarction（STEMI） who underwent primary PCI within 12 hours were enrolled and followed up.All patients were divided into three groups according to serum glucose（SG） on admission：normal group（SG＜7.0 mmol/L，n=148）；SG elevation group（7.0 mmol/L≤SG≤11.1 mmol/L，n=169） and （steady high blood glucose）SHG group（SG＞11.1 mmol/L，n=142）.Myocardial perfusion indexes，including ST segment resolution（STR），TIMI myocardial perfusion grade（TMPG），peak value of creatine kinase CK MB，left ventricular ejection（LVEF），and major adverse cardiac events（MACE） of patients in three groups were measured and compared after emergency PCI.Results The sa levels were increased，ST elevation 2 h after PCI were well declined，the percentages of patients with TMPG 2 3 were decreased and peak values of CK MB were increased in three groups（all P＜0.05）.After 12 months’ follow up，Kaplan Meier survival analysis showed that patients of three groups had significantly different cumulative non events survival rates，89.2％（132/148）vs 85.8％（145/169），76.1％（108/142）(P＜0.05).Muhivariate Cox regression analysis showed that steady high sa were the independent predictor for the occurrence of MACE in patients undergoing PCI after adjusting for age and gender. Conclusion SHG in elderly patients with STEMI can decrease myocardial perfusion level after primary PCI，which will lead to high incidence of MACE.