急性冠状动脉综合征患者住院期间平均血糖和血糖变异系数与预后的相关性

目的 分析急性冠状动脉综合征(ACS)患者住院期间的血糖特点及其与预后的相关性.方法 查阅2003年1月至2006年12月在解放军总医院和中日友好医院心内科以ACS为第一诊断入院、住院时间不少于3d且住院期间测血糖不少于10次的1756例ACS患者的病历资料,平均年龄为(61±9)岁,其中男1270例,有糖尿病史者596例.将每例患者住院期间平均血糖(MBG)及血糖变异系数(GluCV)以四分位法分为4组,分析不同的MBG、GIuCV水平对于所有ACS患者、合并糖尿病及无糖尿病史的ACS患者近期预后包括住院期间发生的主要不良心血管事件(MACE)和死亡]的影响.以住院期间死亡为结局即应变量,Logistic回归分析ACS患者住院期间死亡的独立风险因素.结果 对于总体ACS患者,住院期间MBG>(8.4±2.0)mmoL/L,GluCV>13.33%时,MACE和住院期间死亡率均明显升高(均P<0.05).对于无糖尿病史的ACS患者,MBG>(7.0士2.4)mmol/L时,住院期间MACE的发生率和死亡率均明显升高(均P<0.05).GIuCV>10.47%时住院期间主要不良心血管事件发生率明显升高(P<0.05),GluCV>19.99%时住院期间死亡率明显升高(P<0.05).对于合并糖尿病的ACS患者,MBG>(11.0±3.1)mmol/L时,MACE发生率明显升高(P<0.05),而当MBG>(8.7±1.5)mmoL/L时,死亡率明显升高(P<0.05).GluCV>30.33%时住院期间MACE发生率明显升高(P<0.05),但各组间住院期间死亡率未见明显差别.Logistic回归分析显示ACS患者住院期间死亡的独立风险因素为合并高血压、GluCV、合并糖尿病、MBG、高密度脂蛋白胆固醇,较之MBG,GluCV是更强的住院期间死亡的风险因素(OR值分别为1.479、1.165).结论 ACS患者住院期间的MBG、GluCV 均为住院期间死亡的独立风险因素,住院的ACS患者(尤其是无糖尿病史者),降低血糖变异性可能是其住院期间血糖管理的一个重要方面.

Relationship between prognosis and mean blood glucose and coefficient of variation of blood glucose in patients with acute coronary syndrome during hospitalization

Objective To investigate the relationship between prognosis and blood glucose level in patients with acute coronary syndrome(ACS).Methotis Data were collected from medical records concerning 1756 patients with diagnosis of ACS admitted to department of cardiology of two tertiary public hospitals in Beijing from January 2003 to December 2006,for whom at least 10 glucose measurements were available in no less than 3 days of hospital stay.Of the total cohort,mean age wag(61±9)years,1270were male,596 had a history of diabetes.Coefficient of variation of blood glucose (GIuCV) and mean blood glucose(MBG)during hospitalization were calculated for each patient.Total cohort,diabetic cohort and nondiabetic cohort were divided into four groups according to their quartiles of MBG or GIuCV respectively.The association between glucose indics and adverse in-hospital outcomes(including major adverse cardiovascular events(MACEs)and in-hospital death)was assessed for these three cohort.Multivariate logistic regression with in-hospital death as the dependent variable wag performed to evaluate the independent risk facotr of inhospital death.Results Considering overall population,both MACEs and in-hospital death significantly increased in patients with GluCV>13.33%or MBG>(8.4±2.0)mmoL/L compared with those with lower GluCV Or MBG(P<0.05).For nondiabetic ACS patients.MACEs and in-hospital death occurred more frequently when MBG>(7.0±2.4)mmol/L(P<0.05),MACEs were seen more common when GluCV>10.47%,in-hospital mortality significantly increased when GluCV>19.99%(P<0.05).For diabetic ACS patients,MACEs occurred more frequently when MBG Was above(11.01±3.1)mmol/L(P<0.05)or GluCV above 30.16%(P<0.05),in-hospital death Was more common when MBG>(8.7±1.5)mmot/L,but there were no significant differences in-hospital mortality among GluCV quartiles.Independent predictors of in-hospital mortality Were history of hypertension,GluCV,history of diabetes,MBG and HDL-C,GIuCV Was a stronger predictor of in-hospital death than MBG(OR,1.479;OR,1.165).Conclusions Both MBG and GIuCV are independent predictor for in-hospital death.Decreasing vaffability of blood glucose concentration might be helpful for management of ACS patients,especially for those without preexisting diabetes.