CAJ | 학술논문

目的：了解急性冠状动脉综合征（ACS）患者糖代谢异常的状况，探讨ACS患者48小时内、1周后的糖代谢异常状况是否有一致性以及糖代谢异常、糖化血红蛋白（HbA1c）与ACS患者左心功能的相关性。方法入选2012年1月至2013年2月因ACS入住本院心脏监护病房，既往无糖尿病病史的94例患者。按照ACS的定义分为3组：不稳定型心绞痛、非ST段抬高型心肌梗死、ST段抬高型心肌梗死。入院时抽取随机血糖，进而在发病的48小时内、1周后分别做简化的口服葡萄糖耐量试验（OGTT），入院48小时内抽取HbA1c，比较3组患者血糖水平的变化。结果根据48小时内的OGTT结果显示，糖代谢异常患者72例（76.5%），包括新诊断的糖尿病患者27例（28.7%），糖调节受损（impaired glucose regulation，IGR）患者45例（47.8%）。根据1周后的OGTT结果显示，糖代谢异常患者66例（70.2%），包括新诊断的糖尿病患者23例（24.5%），IGR患者43例（45.7%）。经比较糖代谢异常患者减少6例（6.3%），包括糖尿病患者减少4例（4.2%），IGR患者减少2例（2.1%）。糖代谢状况的前后变化差异无显著性（P＞0.05），仅有极少数患者糖代谢状况在1周后有所好转。糖代谢异常、HbA1c与ACS患者左心收缩、舒张功能有显著相关性（P＜0.05）。结论无糖尿病病史的ACS患者，糖代谢异常普遍存在，ACS患者48小时内、1周后的糖代谢异常状况有一致性，随着梗死程度的加重和梗死面积的扩大，应激也可能参与了糖代谢异常的形成。ACS患者的糖代谢异常、HbA1c水平与左心收缩、舒张功能存在显著相关性。
목적：료해급성관상동맥종합정（ACS）환자당대사이상적상황，탐토ACS환자48소시내、1주후적당대사이상상황시부유일치성이급당대사이상、당화혈홍단백（HbA1c）여ACS환자좌심공능적상관성。방법입선2012년1월지2013년2월인ACS입주본원심장감호병방，기왕무당뇨병병사적94례환자。안조ACS적정의분위3조：불은정형심교통、비ST단태고형심기경사、ST단태고형심기경사。입원시추취수궤혈당，진이재발병적48소시내、1주후분별주간화적구복포도당내량시험（OGTT），입원48소시내추취HbA1c，비교3조환자혈당수평적변화。결과근거48소시내적OGTT결과현시，당대사이상환자72례（76.5%），포괄신진단적당뇨병환자27례（28.7%），당조절수손（impaired glucose regulation，IGR）환자45례（47.8%）。근거1주후적OGTT결과현시，당대사이상환자66례（70.2%），포괄신진단적당뇨병환자23례（24.5%），IGR환자43례（45.7%）。경비교당대사이상환자감소6례（6.3%），포괄당뇨병환자감소4례（4.2%），IGR환자감소2례（2.1%）。당대사상황적전후변화차이무현저성（P＞0.05），부유겁소수환자당대사상황재1주후유소호전。당대사이상、HbA1c여ACS환자좌심수축、서장공능유현저상관성（P＜0.05）。결론무당뇨병병사적ACS환자，당대사이상보편존재，ACS환자48소시내、1주후적당대사이상상황유일치성，수착경사정도적가중화경사면적적확대，응격야가능삼여료당대사이상적형성。ACS환자적당대사이상、HbA1c수평여좌심수축、서장공능존재현저상관성。
Objective To investigate the prevalence of glycometabolic disturbance in patients with ACS, and to assess the consistency between the OGTT results collected in 48 hours and 1 week after the clinical event in patients with ACS, and the correlations between glycometabolic disturbance, HbA1c and cardiac function in patients with ACS. Methods 94 patients with ACS but without previous DM, who were admitted to CCU from January 2012 to February 2013, were included. According to the deifnition of ACS, 94 patients were divided into three groups:unstable angina, non-ST-segment elevation myocardial infarction, ST-segment elevation myocardial infartion. Blood glucose level were tested in admission, simplified OGTT tests were conducted within 48 hours and 1 week after the coronary artery event, HbA1c was tested within 48 hours after the clinical event. The blood glucose levels were compared among the three groups. Results According to the OGTT results collected in 48 hours, glycometabolic disturbance was seen in 72/94 patients (76.5%), the prevalences of newly diagnosed DM and impaired glucose regulation (IGR) were 28.7%(27 patients) and 47.8% (45 patients) respectively. According to the OGTT results collected 1 week after the clinical event, glycometabolic disturbance was seen in 66/94 patients (70.2%), the prevalences of newly diagnosed DM and IGR were 24.5%(23 patients) and 45.7%(43 patients) respectively. Compared with that collected in 48 hours, patients with glycometabolic disturbance were reduced by 6.3%(6 patients), including newly diagnosed DM in 4 patients (4.2%) and IGR in 2 patients (2.1%). The overall change of glycometabolic disturbance within one week was not statistically signiifcant (P>0.05), indicated that the glycometabolic status had improved only in a few patients within one week. Signiifcant correlations between glycometabolic disturbance, HbA1c and left heart systolic, diastolic function in patients with ACS were observed (P<0.05). Conclusion Newly diagnosed DM and IGR was common in patients with ACS and without previous DM history. The OGTT results collected in 48 hours were consistent with that collected 1 week after the clinical event in patients with ACS. With the aggravation of infarct extent and the expansion of infarct area, stress may also involved in the formation of glycometabolic disturbance. The glycometabolic disturbance, HbA1c level showed signiifcant correlations with left heart systolic and diastolic function in patients with ACS.