CAJ | 학술논문

目的分析急性冠状动脉综合征(ACS)患者住院期间的血糖特点及其与预后的相关性.方法查阅2003年1月至2006年12月在解放军总医院和中日友好医院心内科以ACS为第一诊断入院、住院时间不少于3d且住院期间测血糖不少于10次的1756例ACS患者的病历资料,平均年龄为(61±9)岁,其中男1270例,有糖尿病史者596例.将每例患者住院期间平均血糖(MBG)及血糖变异系数(GluCV)以四分位法分为4组,分析不同的MBG、GIuCV水平对于所有ACS患者、合并糖尿病及无糖尿病史的ACS患者近期预后[包括住院期间发生的主要不良心血管事件(MACE)和死亡]的影响.以住院期间死亡为结局即应变量,Logistic回归分析ACS患者住院期间死亡的独立风险因素.结果对于总体ACS患者,住院期间MBG>(8.4±2.0)mmoL/L,GluCV>13.33%时,MACE和住院期间死亡率均明显升高(均P<0.05).对于无糖尿病史的ACS患者,MBG>(7.0士2.4)mmol/L时,住院期间MACE的发生率和死亡率均明显升高(均P<0.05).GIuCV>10.47%时住院期间主要不良心血管事件发生率明显升高(P<0.05),GluCV>19.99%时住院期间死亡率明显升高(P<0.05).对于合并糖尿病的ACS患者,MBG>(11.0±3.1)mmol/L时,MACE发生率明显升高(P<0.05),而当MBG>(8.7±1.5)mmoL/L时,死亡率明显升高(P<0.05).GluCV>30.33%时住院期间MACE发生率明显升高(P<0.05),但各组间住院期间死亡率未见明显差别.Logistic回归分析显示ACS患者住院期间死亡的独立风险因素为合并高血压、GluCV、合并糖尿病、MBG、高密度脂蛋白胆固醇,较之MBG,GluCV是更强的住院期间死亡的风险因素(OR值分别为1.479、1.165).结论 ACS患者住院期间的MBG、GluCV 均为住院期间死亡的独立风险因素,住院的ACS患者(尤其是无糖尿病史者),降低血糖变异性可能是其住院期间血糖管理的一个重要方面.
목적 분석급성관상동맥종합정(ACS)환자주원기간적혈당특점급기여예후적상관성.방법 사열2003년1월지2006년12월재해방군총의원화중일우호의원심내과이ACS위제일진단입원、주원시간불소우3d차주원기간측혈당불소우10차적1756례ACS환자적병력자료,평균년령위(61±9)세,기중남1270례,유당뇨병사자596례.장매례환자주원기간평균혈당(MBG)급혈당변이계수(GluCV)이사분위법분위4조,분석불동적MBG、GIuCV수평대우소유ACS환자、합병당뇨병급무당뇨병사적ACS환자근기예후[포괄주원기간발생적주요불양심혈관사건(MACE)화사망]적영향.이주원기간사망위결국즉응변량,Logistic회귀분석ACS환자주원기간사망적독립풍험인소.결과 대우총체ACS환자,주원기간MBG>(8.4±2.0)mmoL/L,GluCV>13.33%시,MACE화주원기간사망솔균명현승고(균P<0.05).대우무당뇨병사적ACS환자,MBG>(7.0사2.4)mmol/L시,주원기간MACE적발생솔화사망솔균명현승고(균P<0.05).GIuCV>10.47%시주원기간주요불양심혈관사건발생솔명현승고(P<0.05),GluCV>19.99%시주원기간사망솔명현승고(P<0.05).대우합병당뇨병적ACS환자,MBG>(11.0±3.1)mmol/L시,MACE발생솔명현승고(P<0.05),이당MBG>(8.7±1.5)mmoL/L시,사망솔명현승고(P<0.05).GluCV>30.33%시주원기간MACE발생솔명현승고(P<0.05),단각조간주원기간사망솔미견명현차별.Logistic회귀분석현시ACS환자주원기간사망적독립풍험인소위합병고혈압、GluCV、합병당뇨병、MBG、고밀도지단백담고순,교지MBG,GluCV시경강적주원기간사망적풍험인소(OR치분별위1.479、1.165).결론 ACS환자주원기간적MBG、GluCV 균위주원기간사망적독립풍험인소,주원적ACS환자(우기시무당뇨병사자),강저혈당변이성가능시기주원기간혈당관리적일개중요방면.
Objective To investigate the relationship between prognosis and blood glucose level in patients with acute coronary syndrome(ACS).Methotis Data were collected from medical records concerning 1756 patients with diagnosis of ACS admitted to department of cardiology of two tertiary public hospitals in Beijing from January 2003 to December 2006,for whom at least 10 glucose measurements were available in no less than 3 days of hospital stay.Of the total cohort,mean age wag(61±9)years,1270were male,596 had a history of diabetes.Coefficient of variation of blood glucose (GIuCV) and mean blood glucose(MBG)during hospitalization were calculated for each patient.Total cohort,diabetic cohort and nondiabetic cohort were divided into four groups according to their quartiles of MBG or GIuCV respectively.The association between glucose indics and adverse in-hospital outcomes(including major adverse cardiovascular events(MACEs)and in-hospital death)was assessed for these three cohort.Multivariate logistic regression with in-hospital death as the dependent variable wag performed to evaluate the independent risk facotr of inhospital death.Results Considering overall population,both MACEs and in-hospital death significantly increased in patients with GluCV>13.33%or MBG>(8.4±2.0)mmoL/L compared with those with lower GluCV Or MBG(P<0.05).For nondiabetic ACS patients.MACEs and in-hospital death occurred more frequently when MBG>(7.0±2.4)mmol/L(P<0.05),MACEs were seen more common when GluCV>10.47%,in-hospital mortality significantly increased when GluCV>19.99%(P<0.05).For diabetic ACS patients,MACEs occurred more frequently when MBG Was above(11.01±3.1)mmol/L(P<0.05)or GluCV above 30.16%(P<0.05),in-hospital death Was more common when MBG>(8.7±1.5)mmot/L,but there were no significant differences in-hospital mortality among GluCV quartiles.Independent predictors of in-hospital mortality Were history of hypertension,GluCV,history of diabetes,MBG and HDL-C,GIuCV Was a stronger predictor of in-hospital death than MBG(OR,1.479;OR,1.165).Conclusions Both MBG and GIuCV are independent predictor for in-hospital death.Decreasing vaffability of blood glucose concentration might be helpful for management of ACS patients,especially for those without preexisting diabetes.