急性高血糖对ST段抬高性心肌梗死院内预后的影响

目的探讨急性高血糖对ST段抬高性心肌梗死（STEMI）患者院内预后的影响。方法连续人选356例北京地区17家三级和二级医院所有在24h内人院且符合STEMI诊断标准的患者。以入院血糖水平〉11mmol／L判定为高血糖,分为高血糖组和血糖正常组,观察两组患者院内死亡和心血管病事件的发生情况。院内心血管事件定义为院内再发心肌梗死、新发生的心力衰竭、严重心律失常及卒中。结果356例STEMI患者中,存在急性高血糖患者共81例（22．8％）。其院内病死率较无急性高血糖患者显著增加（13．6％比5．1％,P=0．009）,院内心血管事件发生率亦显著增多（32．1％比20．4％,P=0．027）。logistic回归分析示,人院急性高血糖（OR1．615,95％CI1．116～2．338,P=0．011）为STEMI患者院内不良预后的独立危险因素。结论STEMI急性高血糖患者院内死亡及发生院内心血管事件的危险性显著高于人院血糖正常者。人院高血糖为STEMI患者院内不良预后的独立危险因素。

The impact of acute hyperglycemia on the prognosis of ST-segment elevation myocardial infarction

OBJECTIVE: This study was undertaken to assess the effect of acute hyperglycemia on the in-hospital outcomes in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: Between January 2006 and July 2006, 356 patients, from 17 hospitals in Beijing were admitted to the hospitals within 24 hours after the onset of STEMI. They were divided into two groups according to the admission glucose level (cutoff value, 11 mmol/L). The in-hospital mortality and cardiovascular events were compared between the two groups. The in-hospital cardiovascular events were defined as in-hospital reinfarction, new-onset heart failure, malignant arrhythmia and stroke. RESULTS: There were 81 (22.8%) patients with acute hyperglycemia. The in-hospital mortality rate was significantly higher in patients with acute hyperglycemia than in patients without (13.6% VS 5.1%, P = 0.009). The rate of cardiovascular events was also higher in patients with acute hyperglycemia (32.1% VS 20.4%, P = 0.027). By univariate and multivariate logistic regression analysis, high blood glucose on admission (OR, 1.615; 95% CI, 1.116 - 2.338, P = 0.011) was an independent risk factor for in-hospital outcomes. CONCLUSION: The rate of in-hospital mortality and cardiovascular events was significantly higher in STEMI patients with acute hyperglycemia than in patients without. high blood glucose on admission was an independent risk factor for in-hospital outcomes in patients with STEMI.