CAJ | 학술논문

目的探讨老年急性ST段抬高心肌梗死(STEMI)患者并发应激性高血糖(SHG)对急诊经皮冠状动脉介入术(PCI)后心肌灌注水平的影响及与患者临床预后的关系. 方法回顾性分析2008年6月至2010年6月在我院心内科住院初次发生STEMI并在起病12h内成功行急诊PCI治疗的老年非糖尿病患者348例,按入院即刻血糖水平分为3组:(1)正常血糖组(即刻血糖＜7.0mmol/L) 112例;(2)血糖升高组(7.0 mmol/L≤即刻血糖≤11.1 mmol/L)128例;(3)高血糖组(即刻血糖＞11.1 mmol/L)108例.比较3组患者急诊PCI后心肌灌注指标,包括术后2 hST段回落、心肌梗死溶栓试验心肌灌注血流分级(TMPG)及心肌肌酸激酶同工酶峰值,并随访术后12个月内不良心脏事件(MACE)的发生情况. 结果 3组患者随血糖水平升高,术后2 hST段回落良好和TMPG 2～3级比例均降低(均P＜0.01);术后肌酸激酶同工酶峰值升高(均P＜0.01).术后随访12个月,Kaplan-Meier生存分析结果显示,正常血糖组与血糖升高组、高血糖组比较,患者累积无MACE的生存率差异有统计学意义[89.3％(100/112)比85.9％(110/128)、76.3％(83/108),P＜0.05],在校正了年龄、性别后,多因素Cox回归分析结果显示,SHG是老年STEMI患者直接PCI术后MACE发生的独立预测因子.高血糖组患者较正常血糖组患者术后发生MACE的风险增加5.811倍(P＜0.01). 结论老年STEMI患者并发SHG会导致急诊PCI再灌注治疗后心肌灌注水平降低,致使MACE发生率升高.
목적 탐토노년급성ST단태고심기경사(STEMI)환자병발응격성고혈당(SHG)대급진경피관상동맥개입술(PCI)후심기관주수평적영향급여환자림상예후적관계. 방법 회고성분석2008년6월지2010년6월재아원심내과주원초차발생STEMI병재기병12h내성공행급진PCI치료적노년비당뇨병환자348례,안입원즉각혈당수평분위3조:(1)정상혈당조(즉각혈당＜7.0mmol/L) 112례;(2)혈당승고조(7.0 mmol/L≤즉각혈당≤11.1 mmol/L)128례;(3)고혈당조(즉각혈당＞11.1 mmol/L)108례.비교3조환자급진PCI후심기관주지표,포괄술후2 hST단회락、심기경사용전시험심기관주혈류분급(TMPG)급심기기산격매동공매봉치,병수방술후12개월내불양심장사건(MACE)적발생정황. 결과 3조환자수혈당수평승고,술후2 hST단회락량호화TMPG 2～3급비례균강저(균P＜0.01);술후기산격매동공매봉치승고(균P＜0.01).술후수방12개월,Kaplan-Meier생존분석결과현시,정상혈당조여혈당승고조、고혈당조비교,환자루적무MACE적생존솔차이유통계학의의[89.3％(100/112)비85.9％(110/128)、76.3％(83/108),P＜0.05],재교정료년령、성별후,다인소Cox회귀분석결과현시,SHG시노년STEMI환자직접PCI술후MACE발생적독립예측인자.고혈당조환자교정상혈당조환자술후발생MACE적풍험증가5.811배(P＜0.01). 결론 노년STEMI환자병발SHG회도치급진PCI재관주치료후심기관주수평강저,치사MACE발생솔승고.
Objective To investigate the effect of stress-induced hyperglycemia (SHG) on myocardial perfusion and clinical prognosis in elderly patients with acute myocardial infarction (AMI) who underwent primary percutaneous coronary intervention (PCI).Methods 348 elderly patients with first-time occurrence of acute ST-elevation myocardial infarction (STEMI) who underwent primary PCI within 12 hours from June 2008 to June 2010 were enrolled and followed up.All patients were divided into three groups according to serum glucose (SG) on admission:normal group (SG＜ 7.0 mmol/L,n=112);SG elevation group (7.0 mmol/L≤SG≤11.1 mmol/L,n=128) and (steady high blood glucose) SHG group (SG＞11.1 mmol/L,n=108).Myocardial perfusion indexes,including ST segment resolution (STR),TIMI myocardial perfusion grade (TMPG),peak value of creatine kinase CK-MB,left ventricular ejection (LVEF),and major adverse cardiac events (MACE) of patients in three groups,were measured and compared after emergency PCI.Results The blood glucose levels were increased,ST-elevation 2 h after PCI were well declined,the percentages of patients with TMPG 2-3 were decreased and peak values of CK-MB were increased in the three groups (all P＜0.01).After 12 months of follow-up,Kaplan-Meier survival analysis showed that patients of three groups had significantly different cumulative non-events survival rates [89.3％ (100/112) vs.85.9％ (110/128),76.3％ (83/108),P＜0.05].Multivariate Cox regression analysis showed that steady high blood glucose were the independent predictor for the occurrence of MACE in patients undergoing PCI after adjusting for age and gender,and the risk of MACE was increased by 5.811 folds in SHG group as compared with normal group (P＜0.01).Conclusions Stress induced hyperglycemia in elderly patients with STEMI can decrease myocardial perfusion level after primary PCI,which will lead to high incidence of MACE.