中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2012年
1期
19-21
,共3页
丁怀玉%魏明丽%刘俊%周旭晨%朱皓%杨新春
丁懷玉%魏明麗%劉俊%週旭晨%硃皓%楊新春
정부옥%위명려%류준%주욱신%주호%양신춘
心肌梗死%应激性高血糖%C反应蛋白%主要不良心脏事件
心肌梗死%應激性高血糖%C反應蛋白%主要不良心髒事件
심기경사%응격성고혈당%C반응단백%주요불양심장사건
Myocardial infarction%Stress-induced hyperglycaemia%C reactive protein%Major adverse cardiac events
目的 探讨胰岛素治疗对急性ST段抬高型心肌梗死(ASTEMI)伴应激性高血糖患者近期预后的影响.方法 将128例ASTEMI伴应激性高血糖患者随机分为治疗组和对照组各64例,均给予抗凝、抗血小板、他汀类、β受体阻滞剂、硝酸酯类药物和血管紧张素转化酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)治疗,治疗组在此基础上给予50 U胰岛素(选用诺和灵R)加入50 ml生理盐水中静脉泵入.分别在治疗前和治疗后第7天抽取静脉血,测定空腹血糖、超敏C反应蛋白(hs-CRP),并比较两组的近期预后情况.结果 治疗组治疗后空腹血糖较治疗前显著下降[(5.4±0.8)、(11.6±2.3)mmol/L,t =13.97,P＜0.01],而对照组无明显变化[(10.7±2.1)、(11.2±2.7) mmol/L,t =1.79,P＞0.05].两组患者的hs-CRP均较治疗前显著下降[治疗组(6.2±1.5)、(12.8±2.4) mg/L,t=14.26;对照组(8.7±1.8)、(13.1±2.6)mg/L,t=10.97,P均＜0.01].两组治疗后空腹血糖、hs-CRP比较,差异均有统计学意义(t值分别为-9.78、-0.37,P均＜0.01).随访3个月,治疗组患者主要不良心脏事件发生率低于对照组[ 12.50％ (8/64)与34.38％ (22/64),X2=5.02,P＜0.05].结论 胰岛素治疗能改善ASTEMI伴应激性高血糖患者的近期预后.
目的 探討胰島素治療對急性ST段抬高型心肌梗死(ASTEMI)伴應激性高血糖患者近期預後的影響.方法 將128例ASTEMI伴應激性高血糖患者隨機分為治療組和對照組各64例,均給予抗凝、抗血小闆、他汀類、β受體阻滯劑、硝痠酯類藥物和血管緊張素轉化酶抑製劑(ACEI)或血管緊張素受體拮抗劑(ARB)治療,治療組在此基礎上給予50 U胰島素(選用諾和靈R)加入50 ml生理鹽水中靜脈泵入.分彆在治療前和治療後第7天抽取靜脈血,測定空腹血糖、超敏C反應蛋白(hs-CRP),併比較兩組的近期預後情況.結果 治療組治療後空腹血糖較治療前顯著下降[(5.4±0.8)、(11.6±2.3)mmol/L,t =13.97,P＜0.01],而對照組無明顯變化[(10.7±2.1)、(11.2±2.7) mmol/L,t =1.79,P＞0.05].兩組患者的hs-CRP均較治療前顯著下降[治療組(6.2±1.5)、(12.8±2.4) mg/L,t=14.26;對照組(8.7±1.8)、(13.1±2.6)mg/L,t=10.97,P均＜0.01].兩組治療後空腹血糖、hs-CRP比較,差異均有統計學意義(t值分彆為-9.78、-0.37,P均＜0.01).隨訪3箇月,治療組患者主要不良心髒事件髮生率低于對照組[ 12.50％ (8/64)與34.38％ (22/64),X2=5.02,P＜0.05].結論 胰島素治療能改善ASTEMI伴應激性高血糖患者的近期預後.
목적 탐토이도소치료대급성ST단태고형심기경사(ASTEMI)반응격성고혈당환자근기예후적영향.방법 장128례ASTEMI반응격성고혈당환자수궤분위치료조화대조조각64례,균급여항응、항혈소판、타정류、β수체조체제、초산지류약물화혈관긴장소전화매억제제(ACEI)혹혈관긴장소수체길항제(ARB)치료,치료조재차기출상급여50 U이도소(선용낙화령R)가입50 ml생리염수중정맥빙입.분별재치료전화치료후제7천추취정맥혈,측정공복혈당、초민C반응단백(hs-CRP),병비교량조적근기예후정황.결과 치료조치료후공복혈당교치료전현저하강[(5.4±0.8)、(11.6±2.3)mmol/L,t =13.97,P＜0.01],이대조조무명현변화[(10.7±2.1)、(11.2±2.7) mmol/L,t =1.79,P＞0.05].량조환자적hs-CRP균교치료전현저하강[치료조(6.2±1.5)、(12.8±2.4) mg/L,t=14.26;대조조(8.7±1.8)、(13.1±2.6)mg/L,t=10.97,P균＜0.01].량조치료후공복혈당、hs-CRP비교,차이균유통계학의의(t치분별위-9.78、-0.37,P균＜0.01).수방3개월,치료조환자주요불양심장사건발생솔저우대조조[ 12.50％ (8/64)여34.38％ (22/64),X2=5.02,P＜0.05].결론 이도소치료능개선ASTEMI반응격성고혈당환자적근기예후.
Objective To observe the influence of insulin therapy on the short-term prognosis of patients with acute ST-elevation myocardial infarction (ASTEMI) complicated with hyperglycaemia.Methods A total of 128 patients with ASTEMI complicated with hyperglycaemia were randomized into 2 groups:treatment group and control group.There were 64 patients(50.0％ )in the treatment group and 64 patients(50.0％ ) in the control group.All of the patients were given anticoagulants,antiplatelet drugs,statins,beta-receptor blockers,nitrates and angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blocker (ARB) Moreover,the patients in the treatment group were given extra 50 U insulin ( Novolin R) in 50 ml saline by venous infusion.In the treatment group,Venous blood samples were obtained before and 7 days after treatment to determine the fasting blood glucose and hs-CRP in serum; the levels of fasting blood glucose and hs-CRP and short-term prognosis were compared between the 2 groups.Results The levels of fasting blood glucose in the treatment group were decreased significantly after treatment ( [ 5.4 ± 0.8 ] mmol/L vs [ 11.6 ± 2.3 ] mmol/L,P ＜0.01),but there was no significant change in the control group( [ 10.7 ± 2.1 ] mmol/L vs [ 11.2 ± 2.7]mmol/L,P ＞ 0.05 ).The levels of hs-CRP in both groups were decreased significantly after treatment (P ＜0.05),but it was much more obvious in the treatment group( [ 6.2 ± 1.5 ] mg/L vs [ 8.7 ± 1.8 ] mg/L,P ＜0.05).The incidence of major adverse cardiac events(MACE) during a 3 months′ follow-up in the treatment group was significantly lower than that in the control group ( 12.50％ vs 34.38％,P ＜ 0.05 ).Conclusion Insulin therapy can improve the short-term prognosis in patients with ASTEMI complicated with hyperglycaemia.
