CAJ | 학술논문

目的评价平均空腹血糖对ST段抬高型心肌梗死(STEMI)患者住院顶后的影响.方法对357例发病3 d内入院的无糖尿病史的STEMI患者进行回顾性分析,依据入院后72 h内平均空腹血糖水平分为＜5.6、5.6～7.0和＞7.0 mmol/L 三组.比较其临床特征、住院治疗经过和主要心脏事件及死亡的发生率,通过受试者工作特征(ROC)曲线评估平均空腹血糖对住院死亡的预测价值.结果平均空腹血糖＜5.6、5.6～7.0和＞7.0 mmol/L的三组患者分别为165、122和70例,其广泛前壁心肌梗死的比例分别占18.2%、29.5%和45.7%(P＜0.05.各组患者在年龄、既往梗死史及溶栓或经皮冠状动脉介入治疗等差异无统计学意义(P＞0.05).入院时心率、白细胞计数、CK-MB峰值随着平均空腹血糖升高而增加(P＜0.05).随着血糖升高,左心室射血分数降低,心力衰竭、恶性心律失常发生率及住院病死率明显增加(P＜0.05).多因素分析显示入院72 h内平均空腹血糖是住院病死率的独立危险因素(OR=1.31,95%CI:1.10～1.57;P=0.003),其顶测住院死亡ROC曲线下面积为0.758(P＜0.001),而单次入院随机血糖、空腹血糖预测住院死亡的ROC曲线下面积分别为0.674和0.717.结论入院72 h内平均空腹血糖是STEMI住院患者死亡的独立危险因素,其预测价值高于单次的入院随机血糖或空腹血糖.
목적 평개평균공복혈당대ST단태고형심기경사(STEMI)환자주원정후적영향.방법 대357례발병3 d내입원적무당뇨병사적STEMI환자진행회고성분석,의거입원후72 h내평균공복혈당수평분위＜5.6、5.6～7.0화＞7.0 mmol/L 삼조.비교기림상특정、주원치료경과화주요심장사건급사망적발생솔,통과수시자공작특정(ROC)곡선평고평균공복혈당대주원사망적예측개치.결과 평균공복혈당＜5.6、5.6～7.0화＞7.0 mmol/L적삼조환자분별위165、122화70례,기엄범전벽심기경사적비례분별점18.2%、29.5%화45.7%(P＜0.05.각조환자재년령、기왕경사사급용전혹경피관상동맥개입치료등차이무통계학의의(P＞0.05).입원시심솔、백세포계수、CK-MB봉치수착평균공복혈당승고이증가(P＜0.05).수착혈당승고,좌심실사혈분수강저,심력쇠갈、악성심률실상발생솔급주원병사솔명현증가(P＜0.05).다인소분석현시입원72 h내평균공복혈당시주원병사솔적독립위험인소(OR=1.31,95%CI:1.10～1.57;P=0.003),기정측주원사망ROC곡선하면적위0.758(P＜0.001),이단차입원수궤혈당、공복혈당예측주원사망적ROC곡선하면적분별위0.674화0.717.결론 입원72 h내평균공복혈당시STEMI주원환자사망적독립위험인소,기예측개치고우단차적입원수궤혈당혹공복혈당.
Objective To evaluate the impact of mean fasting glucose over the first 72 hours after admission on in-hospital outcomes in patients with ST-segment elevation myocardial infarction ( STEMI ).Methods The data of 357 non-diabetic patients hospitalized with STEMI were collected from the database of Sun Yat-sen Memorial Hospital, affiliated to Sun Yat-sen University between January 2006 and April 2009.The patients were categorized into 3 groups according to mean fasting glucose over the first 72 hours after admission: ＜ 5.6 ( n = 165 ), 5.6 - 7.0 ( n = 122 ) and ＞ 7.0 mmol/L ( n = 70). Clinical characteristics,therapeutic approaches and the incidence of heart failure, malignant arrhythmias, and death during hospitalization were compared among groups. Multivariate logistic regression analysis was performed to determine the association between risk factors and in-hospital outcomes. Receiver-operator characteristic (ROC) curve was generated to assess the power of mean fasting glucose on predicting in-hospital death. Results Age, past history of infarction and early revascularization therapy were similar among groups. Heart rate on admission, white blood cell count, peak CK-MB level, and proportion of extensive anterior infarction were increased in proportion to higher mean fasting glucose levels. Higher mean fasting glucose levels were associated with increased risk of reduced left ventricular ejection fraction, heart failure characterized by higher Killip class, and malignant arrhythmias. After multivariate adjustment, mean fasting glucose remained to be an independent risk factor for increased in-hospital death of patients with STEMI (OR = 1.31, 95% CI: 1.10 - 1. 57;P =0. 003). Mean fasting glucose had the higher area under the ROC curve than admission glucose or fasting glucose after admission based on single measurement (0. 758, 0. 674and 0. 717;P ＜ 0. 001 ). Conclusion Mean fasting glucose during first 72 hours after admission is an independent predictor for in-hospital death and complications in patients with STEMI, which is superior to admission glucose or fasting glucose after admission based on single measurement in predicting in-hospital outcomes.