CAJ | 학술논문

目的探讨入院血糖水平对非糖尿病和合并糖尿病的急性冠状动脉综合征(ACS)患者住院及长期死亡率的预测价值.方法连续选择2008年7月-2010年12月入住北京友谊医院重症心血管病监护病房(CCU)的ACS患者1534例.其中符合入选标准的患者1332例,根据入院血糖不同水平将患者分组,分析各组患者住院期间及长期的全因死亡率.结果在非糖尿病患者中,入院血糖＜ 7.8 mmol/L组(A组)649例,7.8～ 11.1 mmol/L组(B组)203例,≥11.1 mmol/L组(C组)88例；在糖尿病患者中,A组124例,B组142例,C组126例.Cox回归分析显示,在非糖尿病患者中,高入院血糖(B组HR l.48,P=0.05;C组HR2.78,P＜0.001)是长期全因死亡率独立预测因子.在糖尿病患者中,入院血糖≥11.1 mmol/L是长期全因死亡率独立预测因子(HR 2.68,P＜0.001).结论与糖尿病患者相比,无糖尿病史的ACS患者入院血糖水平升高也很常见,是住院及长期预后不良独立预测因素.
목적 탐토입원혈당수평대비당뇨병화합병당뇨병적급성관상동맥종합정(ACS)환자주원급장기사망솔적예측개치.방법 련속선택2008년7월-2010년12월입주북경우의의원중증심혈관병감호병방(CCU)적ACS환자1534례.기중부합입선표준적환자1332례,근거입원혈당불동수평장환자분조,분석각조환자주원기간급장기적전인사망솔.결과재비당뇨병환자중,입원혈당＜ 7.8 mmol/L조(A조)649례,7.8～ 11.1 mmol/L조(B조)203례,≥11.1 mmol/L조(C조)88례；재당뇨병환자중,A조124례,B조142례,C조126례.Cox회귀분석현시,재비당뇨병환자중,고입원혈당(B조HR l.48,P=0.05;C조HR2.78,P＜0.001)시장기전인사망솔독립예측인자.재당뇨병환자중,입원혈당≥11.1 mmol/L시장기전인사망솔독립예측인자(HR 2.68,P＜0.001).결론 여당뇨병환자상비,무당뇨병사적ACS환자입원혈당수평승고야흔상견,시주원급장기예후불량독립예측인소.
Objective To evaluate whether the predictive value of admission hyperglycemia for mortality differs between diabetics and non-diabetics with acute coronary syndrome (ACS).Methods A total of 1534 consecutive patients admitted with ACS to Central Control Unit of Beijing Friendship Hospital were analyzed.Among these patients,1332 patients who had a venous plasma glucose record at admission were retrospectively enrolled and were stratified according to admission glucose levels with or without diabetes.The primary end point was in-hospital and 2-year all-cause mortality.Results In patients without a history of diabetes,649 patients had glucose level ≤7.8 mmol/L(group A),204 patients with 7.8-11.0 mmol/L (group B) and 142 patients ＞ 11.0 mmol/L (group C).Of those with diabetes,124 patients were in group A,142 in group B and 126 in group C.By Cox regression analysis,admission hyperglycemia (group B,HR 1.48,P =0.05 ; group C,HR 2.78,P ＜ 0.001) was an independent predictor of long-term all-cause mortality in patients without diabetes.In patients with diabetes,blood glucose ＞ 11.0 mmol/L (group C,HR 2.68,P ＜ 0.001) also independently predicted long-term all-cause mortality.Conclusions Compared with the diabetic patients,elevation of blood glucose at admission is common in ACS patients without definite history of diabetes.Admission hyperglycemia should be considered as a risk factor strongly correlated with in-hospital and 2-year all-cause mortality in patients with ACS.