探讨老年急性心肌梗死患者冠状动脉介入治疗后ST段与血糖和肌钙蛋白T的关系

目的探讨入院时血糖水平对老年急性心肌梗死(AMI)患者PCI术后ST段下降幅度(STR)和肌钙蛋白T峰值的影响。方法首次AMI的412例老年患者,根据其血糖水平分为3组:A组(血糖<7.0mmol/L)156例;B组(血糖7.0～11.1mmol/L)135例;C组(血糖>11.1mmol/L)121例;分析3组患者急诊PCI术后90minSTR与血浆肌钙蛋白T峰值的相关性。结果C组患者PCI术后90minSTR>70%较A组显著减少(17.96%vs51.49%,P<0.01),B组患者PCI术后90minSTR30%～70%与血糖水平的高低差异无统计学意义(P=0.061);PCI术后,STR>70%的患者肌钙蛋白T峰值低于STR<30%患者(0.033±0.018)ng/Lvs(0.107±0.055)ng/L,P<0.05],差异有统计学意义;logistic回归分析显示,C组肌钙蛋白T峰值升高与血糖的相关性最为密切(r=0.399,P=0.001)。入院时血糖水平与肌钙蛋白T峰值呈显著正相关,入院时血糖水平越高,血清肌钙蛋白T峰值升高越明显。结论入院时血糖升高的老年AMI患者PCI术后,较好的控制血糖对于此类患者有效的心肌再灌注是十分重要的。

The association between glucose on admission and ST-segment resolution and troponin T levels after primary PCI in aged patients with AMI

Objective To investigate the influence of elevated glucose level on ST-segment resolution(STR)and peak levels of troponin T in aged patients with acute myocardial infarction(AMI)treated with primary percutaneous coronary intervention(PCI).Methods 412 aged patients with AMI underwent primary PCI.According to the level of glucose on admission,they were divided into 3 groups:group A <7.0 mmol/L;group B 7.0~11.1 mmol/L;group C >11.1 mmol/L,According to degree of ST-segment resolution(STR)at 90 min after primary PCI,they were divided into 3 groups:group Ⅰ,single lead STR<30%;group Ⅱ,single lead STR 30%-70% and group Ⅲ,single lead STR>70%.Results Compared with group A,patients in group C less frequently had complete ST segment resolution(17.96% vs 51.49%),and there was no relationship between 30%-70% STR and glucose level.Peak levels of troponin T in group Ⅲ were lower than those in group Ⅰ(0.033±0.018 vs 0.107±0.055 ng/L).Logistic regression analysis showed that admission glucose level was positively correlated with peak level of troponin T.Conclusion There is a strong association between admission hyperglycemia and electrocardiographic signs of reperfusion in aged patients with AMI after PCI,suggesting the importance of controlling early blood glucose in effective reperfusion of myocardium.