急性心肌梗死患者左心室功能与入院血糖水平的关系

目的探讨首次急性心肌梗死（AMI）患者入院随机血糖与住院期间左心室功能的关系。方法检测187例AMI患者的入院随机血糖及超声心动图参数。依据入院第一次随机血糖将患者分为3组，G1组（81例）〈7．8mmol／L，G2组（55例）7．8～11．0mmol／L，G3组（51例）〉11．0mmol／L。G1组为血糖正常组，G2组、G3组为血糖升高组。入院血糖与心功能指标之间关系采用直线相关分析。采用Logistic逐步回归法分析心衰发生的危险因素。结果与血糖正常组（G1组）相比，G2组、G3组Killip分级≥Ⅱ级的发生率增加[7．4％（G1组）比20．0％（G2组）、37．3％（G3组），P〈0．05，P〈0.01]；左室舒张末期容积指数[EDVI：（59．04±10．02）ml／m^2（G1组）比（64．31±12．36）ml／m^2（G2组）、（67．82±14．29）ml／m^2（G3组），P〈0．05，P〈0．01]和左室收缩末期容积指数[ESVI：（25．09±9．55）ml／m^2（G1组）比（29．65±10．18）ml／m^2（G2组）、（35．20±12．39）ml／m^2（G3组），P〈0．05，P〈0．01]增大，左室射血分数[EF：0．55±0．06（G1组）比0．51±0．08（G2组）、0．46±0．09（G3组），P〈0．01]降低，二尖瓣E波减速时间[EDT：（197．05±36．59）ms（G1组）比（176．98±46．31）ms（G2组）、（146．35±48．35）ms（G3组），P〈0．05，P〈0．01]缩短。入院血糖与肌酸激酶MB型同工酶（CK—MB）峰值、EDVI、ESVI呈正相关（r值分别为0．231、0．158、0．186，P〈0．05，P〈0．01）；与EDT、EF呈负相关（r值分别为-0．206、-0．155，P〈0．05，P〈0．01）。人院血糖水平是心衰发生的预测因素（相对危险度为1．255，P〈0．01）。结论应激性高糖血症是AMI患者住院期间发生心衰的独立预测因素。

Association between left ventricular function and admission glucose level in patients with acute myocardial infarction

Objective To investigate the relation betweenship serum glucose concentration and left ventriealar dysfunction in patients with acute myocardial infaretion（AMI）. Methods The glucoses and echocardiography were measured and evaluated in one hundred and eighty-seven patients with AMI on admission. According to admission glucose level,a total of 187 patients with AMI were divided into 3 groups： 〈7.8 mmol/L（group 1, G1 ）, 81 cases,7.8-11.0 mmol/L （group 2, G2）,55 cases,〉11.0 mmol/L （group 3,G3）,51 cases. Correlation between admission glucose level and parameters of echocardiogram were obtained using linear regression analysis, and the logistic regression analysis was performed to identify independent predictors of heart failure. Results Compared with G1,the incidences of Killip class ≥ Ⅱ was significantly higher in G2 and G3 [7.4%（G1） vs 20%（G2）, vs 37.3%（G3）,P〈0.05,P〈0.01 ] ,left ventricular end-diastolic volume index [（EDVI： （59.04±10.02）ml/m^2（G1） vs （64.31±12.36）ml/m^2（G2）, vs （67.82±14.29）ml/m^2（G3）, P〈0.05, P〈0.01] and left ventricular end-systolic volume index[ESVI： （25.09±9.55）ml/m^2（G1） vs （29.65±10.18）ml/m^2（G2）, vs （35.20±12.39）ml/m^2（G3）, P〈 0.05, P〈0.01 ] were increased, but left ventricular ejection fraction[0.55±0.06（G1 ） vs 0.51±0.08（G2）, vs 0.46± 0.09 （G3）,P〈0.01] and mitral E-wave deceleration time [EDT： （197.05±36.59）ms（G1） vs （176.98±46.31）ms （G2）, （146.35±48.35）ms （G3）, P〈0.05, P〈0.01] were lower. Correlation analysis showed that admission glucose was positively correlated with creatine kinase-MB（CK-MB）,EDVI and ESVI（r=0.231, 0.158, 0.186, P〈0.05, P〈0.01 ） ,inversely correlated with EDT and EF （r=-0.208, -0.155, P〈0.05, P〈0.01 ）. Logistic regression analysis showed that the admission glucose level was an independent prognostic factor for heart failure （OR =1.255,P〈 0.01 ）, along with CK-MB and restrictive filling. Conclusion Hyperglycemia on admission is an independent predicator of heart failure during hospitalization in patients with AMI.