评估应激性高血糖对急性ST段抬高心梗患者不良心血管事件发生和远期预后的影响

目的：探讨血糖高应激状态对ST段抬高型急性心肌梗死（STEMI）患者不良心血管事件发生及远期预后的影响。方法：选取2013年2月-2018年2月杭州市第一人民医院收治的STEMI患者448例，根据血糖检测浓度分为应激性高血糖组91例与正常血糖组357例。2组入院后完善相关检查信息，均采用经皮冠状动脉造影检查联合介入手术治疗。统计2组住院期间不良心血管事件与出院随访1年内远期预后情况等。结果：合并应激性高血糖的STEMI患者手术前实验室检查指标如肌钙蛋白、随机血糖、白细胞计数等，与未合并应激性高血糖的患者比较均有显著差异（P<0.05）。应激性高血糖组患者住院时与出院随访期间发生的不良心血管事件及死亡率均高于正常血糖组（P<0.05）。多因素Logistic回归分析显示高血压病史、应激性高血糖、LVEF与患者不良心血管事件及远期预后显著相关（P<0.05）。ROC曲线分析显示入院时血糖检测对预测住院期间不良心血管事件及远期预后的AUC分别为0.738、0.823，P<0.05。结论：应激性高血糖会影响STEMI术后不良心血管事件发生及远期预后结局，患者就诊后及时监测血糖指标并加强早期干预十分重要。

The effect of stress hyperglycemia on adverse cardiovascular events and long-term prognosis in patients with acute ST-segment elevation myocardial infarction

OBJECTIVE To investigate the effect of hyperglycemic stress on adverse cardiovascular events and long-term prognosis in patients with ST-segment elevation acute myocardial infarction (STEMI).METHODS A total of 448 patients with STEMI admitted to the First People's Hospital of Hangzhou from February 2013 to February 2018 were selected and divided into stress hyperglycemia group (n=91) and normoglycemia group (n=357) according to the blood glucose detection concentration. The relevant inspection information in both groups were supplemented after admission, and the patients were treated with percutaneous coronary angiography combined with interventional surgery. The adverse cardiovascular events during hospitalization and long-term prognosis within 1 year after discharge follow-up were statistically analyzed.RESULTS Preoperative laboratory test indexs such as troponin, random blood glucose, and white blood cell count in STEMI patients with stress hyperglycemia were significantly different from those without stress hyperglycemia (P<0.05). The incidence of adverse cardiovascular events and mortality in the stress hyperglycemia group was higher than that in the normoglycemia group (P<0.05). Multivariate logistic regression analysis showed that the history of hypertension, stress hyperglycemia, and LVEF were significantly correlated with adverse cardiovascular events and long-term prognosis (P<0.05). ROC curve analysis showed that the AUC of the blood glucose test at admission for adverse cardiovascular events and long-term prognosis during hospitalization was 0.738, 0.823, P<0.05.CONCLUSION Stress-induced hyperglycemia may affect the occurrence of adverse cardiovascular events and long-term outcome after STEMI. It is of great significance to monitor blood glucose indicators and strengthen early intervention after the patient visits.