糖化血红蛋白与急性心肌梗死预后的关系研究

目的观察糖化血红蛋白（HbA1c）与急性心肌梗死预后的关系。方法选择2008年1月至2008年12月发病时间〈12h的sT段抬高心肌梗死（STEMI）474例患者，根据入院时HbA1c水平分为2组，即HbA1c升高组（HbA1cI〉6．5％）与对照组（HbA1c〈6．5％），分析2组患者的糖化血红蛋白与急性心肌梗死预后的关系。结果两组患者在年龄、吸烟史、前壁AMI、发病至就诊时间、冠脉造影例数、成功再灌注率及住院期间药物应用情况等方面差异无统计学意义（P〉0．05）。而HbA1c升高组患者糖尿病史（P=0．000），高血压史（P=0．008），入院时血糖水平（P=0．000），三支病变比例（P=0．031）方面显著高于对照组，男性比例（P=0．006），左心室射血分数（P=0．023）及单支病变比例（P=0．040）则明显低于对照组，两组之间差异有统计学意义。HbA1c升高组患者住院期间发生心力衰竭（P=0．041），心源性休克（P=0．038）及病死率（P=0．033）明显高于对照组，两组之间的差异有统计学意义。而两组患者住院期间发生恶性心律失常如室颤室速情况差异无统计学意义。多因素分析结果显示，HbA1c升高是影响住院期间发生心力衰竭（OR=1．467，95％CI：0．473～3．149，P=0．047）及病死率（OR=0．932，95％CI：0．311～1．124，P=0．044）的独立危险因素。结论HbA1c水平升高是住院期间发生心力衰竭及病死率的强预测因子，应重视HbA1c对判断AMI患者预后的作用，充分估计病情，指导患者控制血糖，改善预后。

The predictive value of glycosylated hemoglobin level in patients with acute myocardial infarction

Objective To evaluate the glycosylated hemoglobin (HbA1c) level in patients with acute myocardial infarction.Methods The data of 474 in-hospital patients with ST-elevation myocardial infarction were collected from database of Beijing Anzhen Hospital from January to December 2008.The patients were divided into two groups according to the level of HbA1c:HbAlc≥6.5% group and control group (HbAlc＜6.5%).The prognosis of two groups were observed.Results Age,smoke,ischemic time,cases of coronary angiography,successful reperfusion rate,in-hospital drug us were no significant different between two groups(P＞0.05).Compared with the control group,history of hypertension(P=0.008) and diabetes (P=0.000),blood glucose (P=0.000),triplevessel disease (P=0.031),male (P=0.006),LVEF (P=0.023) and single-vessel disease (P=0.040) were significantly different in HbA1c≥6.5% group.In HbA1c≥6.5% group,there was higher incidence of heart failure (P=0.041),in-hospital mortality (P=0.033),cardiogenic shock (P=0.038).Logistic analysis showed that HbA1c≥6.5% were independent factors of in-hospital mortality(OR=0.932,95% CI:0.311-1.124,P=0.044) and the rate of heart failure (OR=1.467,95% CI:0.473-3.149,P=0.047).Conclusions The high level of HbA1c is a powerful predictor of in-hospital mortality and incidence of heart failure in patients with acute myocardial infarction.The prognosis of AMI can be improved by the control of blood sugar.