2021 年第 7 期 第 16 卷

入院血糖水平与急性ST段抬高型心肌梗死患者预后的关系

Relationship between admission blood glucose level and prognosis of patients with acute ST segment elevation myocardial infarction

作者：克热穆江·麦图荪1刘新林2杨清1

英文作者：Keremujiang Maitusun1 Liu Xinlin2 Yang Qing1

单位：1天津医科大学总医院心血管内科300052；2武警特色医学中心心血管内科，天津300162

英文单位：1Department of Cardiovascular Medicine General Hospital of Tianjin Medical University Tianjin 300052 China; 2Department of Cardiovascular Medicine Characteristic Medical Center of People′s Armed Police Tianjin 300162 China

关键词：急性ST段抬高型心肌梗死；入院血糖；心血管预后

英文关键词：AcuteSTsegmentelevationmyocardialinfarction;Admissionbloodglucose;Cardiovascularprognosis

• 摘要：

• 目的 探讨入院血糖水平与急性ST段抬高型心肌梗死（STEMI）患者预后的关系。方法 分别入选2012年11月至2013年5月以及2015年1—11月在武警特色医学中心就诊并接受急诊经皮冠状动脉介入（PCI）的急性STEMI患者220例。根据入院血糖与随访期间主要不良心血管事件（MACE）发生的关系，以使MACE发生风险显著升高的血糖水平为截断值对总体患者进行分组，并比较2组患者的基线资料，构建Cox回归模型。基于该模型，对比2组患者MACE发生的风险差异，并进行亚组分析。结果 220例患者中位随访时间为32.4个月，共62例患者发生MACE。按照截断值将STEMI患者分为2组（入院血糖＜11.0 mmol/L组和入院血糖≥11.0 mmol/L组）。未经校正和校正后Cox比例风险回归模型分析结果均显示，与入院血糖＜11.0 mmol/L组相比，≥11.0 mmol/L组患者随访发生MACE的风险均更高（校正后：风险比=2.35，95%置信区间：1.18～4.68，P=0.015）。亚组分析显示，年龄≥60岁、男性、既往无高血压病史、既往有糖尿病病史亚组患者在入院血糖≥11.0 mmol/L时随访期间发生MACE的风险更高（均P＜0.05）。结论 接受急诊PCI治疗的STEMI患者入院血糖≥11.0 mmol/L可增加远期发生MACE的风险。

• Objective To investigate the relationship between admission blood glucose level and prognosis of patients with acute ST segment elevation myocardial infarction (STEMI). Methods Totally 220 patients with acute STEMI who received emergency percutaneous coronary intervention (PCI) in Characteristic Medical Center of People′s Armed Police from November 2012 to May 2013 and from January to November 2015 were enrolled. According to the relationship between admission blood glucose and major adverse cardiovascular events (MACE), the blood glucose level that significantly increased risk of MACE was used as cut-off value for the overall grouping, the baseline data of the two groups were compared, and the Cox regression model was constructed. Based on this model, the risk differences of MACE between the two groups were compared, and subgroup analysis was performed. Results The median follow-up time of 220 patients was 32.4 months, and MACE occurred in 62 patients. According to the cut-off value, patients with STEMI were divided into two groups (admission blood glucose ＜11.0 mmol/L group and admission blood glucose ≥11.0 mmol/L group). The results of Cox proportional risk regression model analysis before and after adjusting showed that the risk of MACE in patients of admission blood glucose ≥11.0 mmol/L group was higher than that of admission blood glucose ＜11.0 mmol/L group (after adjusting: hazard ratio=2.35, 95% confidence interval: 1.18-4.68, P=0.015). The subgroup analysis showed that age ≥60 years old, male, without previous hypertension history and with previous diabetes history in patients with admission blood glucose ≥11.0 mmol/L had higher risk of MACE during follow-up period. Conclusion STEMI patients who received emergency PCI treatment with admission blood glucose ≥11.0 mmol/L have a higher risk of MACE in the long term.