应激性高血糖对急性ST段抬高型心肌梗死患者远期预后的影响

目的探讨急性sT段抬高型心肌梗死（STEMI）患者发生应激性高血糖的相关危险因素，并评估应激性高血糖对STEMI患者远期预后的影响。方法白求恩国际和平医院2009年8月至2010年4月92例初次发生STEMI的非糖尿病住院患者，根据入院后测定的空腹血糖或随机血糖分A组（应激性高血糖组）41例和B组（血糖正常组）51例。平均随访1．5年。结果应激性高血糖的发生率是44．6％（41／92）。A和B组间经logistic回归分析提示女性（OR=8．952，P=0．013）、心功Killip分级越高（OR=3．530，P=0．048）、肌酸激酶同工酶（CK．MB）峰值越高（OR=9．408，P〈0．001）均是应激性高血糖发生的相关危险因素。Cox回归对A和B组患者1～2年内发生的死亡风险进行分析，提示应激性高血糖是远期死亡（RR1．532，95％CI1．004--2．337，P=0．048）的独立预测因子。高甘油三酯血症患者远期死亡风险是正常者1．557倍（P=0．041）。结论女性、Killip分级、CK．MB增高是应激性高血糖发生的相关危险因素。应激性高血糖可能是STEMI患者远期预后不良的独立预测因子和危险因素。高甘油三酯血症可能加重患者的死亡风险。

Effect of stress hyperglycemia on long-term prognosis of patients with ST segment elevation acute myocardial infarction

Objective To evaluate the predictors of stress hyperglycemia in patients with ST segment elevation acute myocardial infarction （STEMI） and the effect of stress hyperglycemia on the long-term prognosis of these patients. Methods A total of 92 patients who had no diabetes but sufferred from STEMI for the first time admitted in our hospital from August 2009 to April 2010 were enrolled in this study. The patients were divided into stress hyperglycemia group （n = 41） and normal blood glucose group （n = 51） according to the results of fasting blood glucose or random blood glucose after admission. The patients were followed up for 1.5 years on average. Results The prevalence of stress hyperglycemia was 44.6% （41/92）. Logistic regression analysis indicated that female （OR = 8.952, 95% CI -- 1.579 to 50.757, P = 0.013）, higher Killip class （OR = 3.530, 95% CI = 1.010 to 12.336, P = 0.048）, and higher creatine kinase （CK）-MB （OR = 9.408, 95%CI = 2.782 to 31.818, P 〈 0.001） were the independent predictors of stress hyperglycemia. Cox proportional hazard regression model presented that stress hyperglycemia was an independent predictor for 1 to 2 years mortality （RR = 1.532, 95% CI = 1.004 to 2.337, P = 0.048）. The long-term mortality risk of patients with hypertriglyceridemia was 1.557 times higher than those with normal triglycerides （P = 0.041）. Conclusion Female, higher Killip class, and higher CK-MB are the independent predictors for stress hyperglycemia after STEMI. Stress hyperglycemia is an independent predictor and risk factor for long-term unfavorable prognosis in STEMI patients. Hypertriglyceridemia may increase the risk of death in these patients.