糖尿病与急性期高血糖对急性心肌梗死患者近期预后的影响

目的探讨糖尿病及急性期血糖水平对急性心肌梗死患者院内死亡、心功能不全及感染发生的相关关系.方法对146例急性心肌梗死患者分别以糖尿病和入院血糖水平作为分组的切点比较两组院内死亡、心功能不全和感染发生比率的差异.并通过Logistic回归分析探讨影响预后的相关危险因素.结果糖尿病组的院内死亡率高于非糖尿病组但无统计学差异;糖尿病组心功能不全及感染的发生比率明显高于非糖尿病组.入院血糖是院内死亡(OR=1.504,P=0.002)和感染(OR=1.160,P=0.036)发生的独立危险因素;入院前3天平均血糖是发生心功能不全(OR=1.480,P=0.001)的独立危险因素.结论急性期血糖水平是急性心肌梗死患者发生院内感染、心功能不全和死亡的相对独立危险因素.这提示我们对心肌梗死急性期的高血糖应积极加以控制以改善急性心肌梗死患者的近期预后.

The Effect of Diabetes and Acute Hyperglycemia on the Prognosis in patients with Acute Myocardial Infarction

Objective To assess the effect of diabetes mellitus (DM) and hyperglycemia in acute stage on outcomes in patients with acute myocardial infarction (AMI). Methods 146 adult patients with AMI were divided into two groups according to the history of DM or the admission glucose. The in-hospital mortality,the rates of heart failure and infection were compared between the groups. We identify the independent risk factor of prognosis by Backward Logistic regression analysis. Results There was no significant difference between two groups in the in-hospital mortality rate,the rates of heart failure, and infection were significantly higher in the patients with diabetes than non-diabetic patients. The high blood glucose is a bad prognostic indicator in patients with AMI. Conclusion Hyperglycemia might be associated with poor in-hospital prognosis among patients after AMI whether the patients have diabetes. It suggested that well controlling on high blood glucose in acute stage may improve the in-hospital prognosis of AMI.