不同入院血糖水平对ST段抬高的急性心肌梗死患者近期病死率的影响

目的 探讨ST段抬高的急性心肌梗死(STEMI)患者入院时不同血糖水平与近期病死率的相关性.方法 观察性分析国际性随机对照临床试验中7446例出现症状12 h内STEMI的中国患者以入院血糖水平分成6组,分别为人院血糖水平＜4.5 mmol/L组(血糖偏低组),血糖水平4.5～5.5 mmol/L组,5.6～7.0 mmol/L组,7.1～8.5 mmol/L组(血糖轻度升高组)和8.6～11.0 mmol/L组(血糖中度升高组),血糖＞11.0 mmoL/L组(高血糖组).分析6组患者30 d的病死率.以血糖水平4.5～5.5 mmol/L组作为对照组,与其他血糖水平组进行比较.结果 高血糖组病死率(18.6%,P=0.01)比血糖水平4.5～5.5 mmol/L组,血糖偏低组(10.2%,P=0.018)、血糖轻度升高和中度升高组(9.2%,P:0.01;11.6%,P＜0.01)均明显升高.多因素Lngistie回归分析显示血糖轻度和中度升高组(7.1～8.5 mmol/L和8.6～11.0 mmol/L)死亡危险分别比正常血糖患者增加46%(OR 1.46,95% CI 1.03～2.07,P=0.01)和58%(OR 1.58,95% CI 1.13～2.22,P=0.02),高血糖组死亡危险比正常血糖患者增加126%(OR 2.26,95% CI 1.62～3.14,P＜0.01).入院血糖偏低、轻中度升高和高血糖是30 d病死率的独立危险因素.结论 入院血糖偏低、轻中度血糖升高和高血糖的STEMI患者近期病死率均明显升高.血糖水平是与STEMI患者近期预后相关的重要因素.

Effect of admission blood glucose levels on the short term mortality in patients with acute ST-segment elevation myocardial infarction

Objective To evaluate the predictive value of different admission blood glucose levels for short-term mortality in patients with ST-segment elevation acute myocardial infarction (STEMI).Method An observational analysis of 7446 Chinese STEMI patients from a global randomized controlled trials were recruited within 12 hours of symptom onset According to the levels of admission glucose,these patients were divided into six groups,admission glucose ＜ 4.50 mmol/L was defined as the hypoglycemia group;glucose of 4.5-5.5 mmol/L a control;5.6-7.0 mmol/L,7.1-8.5 mmol/L (mild hyperglycemia group) and 8.6-11.0 mmol/L (moderate hyperglycemia group );glucose ＞ 11.0 mmol/L was the severe hyperglycemia group.The 30-day mortality was analyzed.Result Compared with the glucose of 4.5-5.5mmol/L group,thirty-day mortality increased in patients with hypoglycemia (10.2%,P ＜ 0.05 ),mild and moderate hyperglycemia (9.2%,P = 0.01 ;11.6%,P ＜ 0.01,respectively) and severe hyperglycemia (18.6% ,P ＜0.01 ).The highest mortality occurred in the severe hyperglycemia group.Multivariate logistic regression analysis showed that,as compared with glucose of 4.5-5.5 mmol/L,the mild and the moderate hyperglycemia groups had a mortality increasing of 46% (OR 1.46,95% CI 1.03-2.07,P = 0.01 ) and 58% fold (OR 1.58,95% CI 1.13-2.22 P=0.02) respectively;the severe hyperglycemia group had a risk of death of 2.26 folds (OR 2.26,95% CI 1.62-3.14,P = 0.05 ).Mild,moderate and severe hyperglycemia were independent predictors of 30-day mortality.Conclusion The 30-day mortality was higher in STEMI patients with mild,moderate and severe hyperglycemia at admission.Admission blood glucose level is an important factor associated with a short-term.