空腹血糖水平对初发急性心肌梗死患者预后的影响

目的 探讨空腹血糖（FBG）水平与初发急性心肌梗死患者近期和远期预后的关系及临床意义.方法 668例初发急性心肌梗死患者根据有无糖尿病病史和人院次日FBG浓度分为糖尿病组（n=177）、高FBG组（n=351）和正常FBG组（n=140）.分别记录各组患者近期心血管事件发生情况和随访期间死亡情况,并对相关因素进行统计学分析.结果 Logistic和Cox回归分析表明,FBG是初发急性心肌梗死患者近期发生恶性心律失常（比值比OR=1.106,P=0.001）、充血性心力衰竭（OR=1.060,P=0.037）、心源性休克（0R=1.084,P=0.018）和心源性死亡（OR=1.068,P=0.028）的独立危险因子和远期死亡的独立预测因子（OR=1.043,P=0.004）.Cox回归分析显示,高FBG组FBG〉8.52 mmol/L和糖尿病组FBG〉10.65 mmoL/L患者的死亡风险是正常FBG组患者的3倍（风险比值HR=3.087,P=0.007;HR=3.456,P=0.002）.结论 FBG是初发急性心肌梗死患者近期心血管事件和远期死亡的独立影响因素.

Effects of fasting blood glucose on outcomes of patients with primary acute myocardial infarction

Objective To investigate the relationship between fasting blood glucose ( FBC) and short-term and long-term outcomes of patients with primary acute myocardial infarction. Methods Six hundred and sixty-eight patients with primary acute myocardial infarction were divided into diabetes mellitus group (n = 177), high FBG group (n = 351) and normal FBG group (n = 140) on the basis of history of diabetes mellitus and FBG level on the next day after admission. The incidences of short-term cardiovascular events and mortality during follow-up in each group were recorded, and the related factors were statistically analysed. Results Logistic and Cox regression analysis revealed that FBG was independent risk factor for long-term death ( OR = 1. 043, P = 0. 004) and short-term events of malignant arrhythmia ( OR = 1. 106, P = 0. 001), congestive heart failure ( OR = 1.060, P = 0. 037), cardiac shock ( OR = 1. 084, P = 0. 018) and cardiac death ( OR = 1.068, P= 0.028). Cox regression analysis indicated that the mortality risks of FBG > 8. 52 mmol/L in high FBG group and FBG > 10. 65 mmol/L in diabetes mellitus group were three times of that of normal FBG group (HR = 3. 087, P = 0.007; HR =3.456, P =0.002). Conclusion FBG is independent risk factor for short-term cardiovascular events and long-term mortality in patients with primary acute myocardial infarction.