急性心肌梗死患者急性期高血糖与心血管不良事件的相关性研究

目的 探讨不同类型心肌梗死患者急性期高血糖与其心血管不良事件及病情严重程度的关系。方法 将183例急性心肌梗死（AMI）患者分为ST段抬高型84例(STEMI)及非ST段抬高型99例（NSTEMI），根据入院即刻血糖(ABG)、入院后首次（次日）空腹血糖(FBG)、是否合并有糖尿病为切点，回顾性分析各组患者住院期间急性期高血糖与主要心血管不良事件（心力衰竭、恶性心律失常、死亡）以及心梗后心功能状态的相关指标（Killip分级、LVEF、BNP）和心梗后心肌缺血、病变严重程度及范围的相关指标（冠脉病变支数、Gensini积分）的关系。结果 ABG、FBG 水平与 Killip分级、BNP、冠脉病变支数、Gensini积分等指标均呈正相关，与LVEF值均呈负相关，且相关程度STEMI均较NSTEMI更明显。结论 急性期高血糖水平在STEMI患者中对心血管不良事件发生率的预测较 NSTEMI患者更好，心梗后心功能状态、冠脉病变程度相关性更高，有助于住院期间不良心血管事件及心梗后心功能的判断，可作为STEMI患者危险分层及评估心梗后高危人群的一个简易临床指标。

Relationship Between Acute Hyperglycemia and Adverse Cardiovascular Events in Patients with Acute Myocardial Infarction.

Objective To investigate the relationship between acute hyperglycemia and adverse cardiovascular events and severity of illness in different types of acute myocardial infarction patients. Methods 183 patients with acute myocardial infarction (AMI) were divided into ST-elevation myocardial infarction(STEMI, NO. 84) and non-ST elevation myocardial infarction(NSTEMI, NO. 99). According to the level of admission blood glucose(ABG), the first fasting blood glucose(FBG) and whether the patients complicated with diabetes mellitus respectively. Retrospective analysis the relationship between acute hyperglycemia and In-hospital major adverse cardiovascular events of patients in each group: (Heart failure , Malignant arrhythmia, Death) and correlation the index of cardiac function after myocardial infarction (Killip classification, LVEF, BNP), and the index of myocardial ischemia, lesion severity and range after myocardial infarction (The number of coronary artery lesions, Gensini integral) et. Results ABG level and FBG level were both positively related with Killip classification, BNP, the number of coronary artery lesion and Gensini score in patients with STEMI. At the same time, ABG level and FBG level were both negatively related with LVEF. And the correlation degree in the STEMI patients was more obvious than in the NSTEMI patients. Conclusions The Acute hyperglycemia level, used as the illness weight indicator of patients with ST-elevated acute myocardial infarction is more meaningful than of patients with Non-st elevated acute myocardial infarction, and it also can reflect cardiac function and the severity of coronary artery lesions after AMI. The Acute hyperglycemia, as a simple clinical indicator, may be helpful for the risk stratification and prognosis determination of STEAMI.