急性心肌梗死初发高血糖的临床研究

目的:探讨急性心肌梗死(AMI)初发高血糖的临床研究即既往无糖尿病病史的AMI患者发病早期血糖变化规律,及高血糖与口服葡萄糖耐量试验(OGTT)的关系,以明确反应性高血糖变化规律并及早发现合并糖尿病和糖调节受损的患者以指导治疗。方法:从2009-02到2009-09,连续入选既往无糖尿病病史,且在发病48 h内接受急诊经皮冠状动脉治疗的ST段抬高型AMI患者,在入院即刻和入院后第2～7天连续6天清晨6点采集患者空腹血液,化验血糖浓度,在出院前进行OGTT,共纳入有效病例158例,按照1999年世界卫生组织OGTT分类标准分为糖代谢正常者、糖调节受损者和新诊断糖尿病者;非糖尿病患者包括糖代谢正常者和糖调节受损者,评价血糖水平在心肌梗死急性期的变化规律。以入院第2天空腹血糖≥7.0 mmol/L为高血糖,评价高血糖与OGTT阳性的关系。结果:158例患者中糖代谢正常者占27.8%(44/158)、糖调节受损者占41.1%(65/158)、新诊断糖尿病者占31.0%(49/158)。所有患者平均血糖在入院后第4天降至正常水平,糖代谢正常者平均血糖在入院后第2天降至正常水平,非糖尿病患者平均血糖在第3天降至正常水平。空腹高血糖与OGTT阳性一致性检验Kappa=0.338,P=0.000,在校正其他变量的情况下,第2天空腹血糖≥7.0 mmol/L都是糖尿病(OGTT阳性)的预测因素(风险比=4.75,95%可信区间2.304～9.79,P=0.000)。结论:既往无糖尿病病史的AMI患者绝大多数合并糖代谢异常,需要进一步通过OGTT及时发现合并糖尿病或糖调节受损的患者以指导临床治疗;AMI患者反应性高血糖一般持续2～3天,如果存在持续高血糖提示患有糖尿病或糖调节受损的可能性大。高血糖是患有糖尿病的一个预测因素。

Clinical Study of Hyperglycemia in Patients With Acute Myocardial Infarction

Objectives:To assess the hyperglycemia in patients at the early stage of acute myocardial infarction(AMI) and to explore the relationship between hyperglycemia and oral glucose tolerance test(OGTT) for guiding the treatment.Methods:We studied 158 AMI patients without previous history of diabetes mellitus(DM) in our hospital from February to September 2009.All patients had ST segment elevated AMI and received PCI within 48 hours of the onset.The blood glucose at admission and the fasting glucose at the 2nd～7th days were examined,OGTT was conducted before discharge in all patients.According to WHO standard of OGTT in 1999,the patients were divided as normal glucose metabolism,impaired glucose regulation and newly diagnosed DM.Hyperglycemia was defined as the fasting glucose ≥ 7.0 mmol/L in the 2nd morning of admission,the relationship between hyperglycemia and positive OGTT was evaluated.Results:There were 27.8%(44/158) of patients with normal glucose metabolism,41.1%(65/158) with impaired glucose regulation,and 31.0 %(49/158) had newly diagnosed DM.The average glucose reached normal level on the 2nd day for patients with normal glucose metabolism,on 3rd day for non-DM patients,on 4th day for all patients.The accordance between fasting hyperglycemia and positive OGTT was as Kappa = 0.338,P=0.000.With the adjusted variations,the fasting glucose ≥ 7.0 mmol/L on the 2nd day of admission were the predictors for DM,and OR=4.75,95% CI 2.304~9.79,P=0.000.Conclusion:Most AMI patients without previous history of DM may combine with abnormal glucose metabolism,OGTT should be performed to find the early impairment.Persistent fasting hyperglycemia is the risk predictor for DM.