血糖波动对急性心肌梗死患者左心室功能的影响研究

摘要

目的：探讨血糖波动对急性心肌梗死患者左心室功能的影响。方法选取2013—2015年无锡市第九人民医院收治的急性心肌梗死患者200例，根据平均血糖波动幅度（MAGE）分为 MAGE ﹤3.9 mmol/ L 组122例（A 组）与 MAGE≥3.9 mmol/ L 组78例（B 组）。比较两组患者一般资料、实验室检查结果、心功能指标，并分析 MAGE 对急性心肌梗死患者左心室功能的影响。结果两组患者性别、年龄、体质指数（BMI）、高血压病史阳性率、慢性阻塞性肺疾病病史阳性率、脑卒中病史阳性率、收缩压（SBP）、舒张压（DBP）、心率比较，差异无统计学意义（P ﹥0.05）；A 组患者糖尿病病史阳性率低于 B 组（P ﹤0.05）。两组患者总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、舒张期末容积指数比较，差异无统计学意义（P ﹥0.05）；A 组患者空腹血糖、糖化血红蛋白（HbA1c ）低于 B 组，收缩期末容积指数小于 B 组，左心室射血分数（LVEF）、每搏输出量高于 B组，Killip 分级优于 B 组，室壁运动积分指数大于 B 组（P ﹤0.05）。多因素 logistic 回归分析结果显示，MAGE〔OR =1.567，95% CI（1.021，2.178）〕是急性心肌梗死患者左心室功能的影响因素（P ﹤0.05）。结论血糖波动会影响急性心肌梗死患者左心室功能，MAGE 是急性心肌梗死患者左心室功能的影响因素之一。%Objective To explore the impact of glycemic excursions on left ventricular function of patients with acute myocardial infarction. Methods A total of 200 patients with acute myocardial infarction were selected in the Ninth People's Hospital of Wuxi from 2013 to 2015,and they were divided into A group(with mean amplitude of glycemic excursions less than 3. 9 mmol/ L,n = 122)and B group(with mean amplitude of glycemic excursions equal or over 3. 9 mmol/ L,n = 78)according to the mean amplitude of glycemic excursions. General information,laboratory examination results,index of cardiac function were compared between the two groups,and the impact of mean amplitude of glycemic excursions on left ventricular function was analyzed. Results No statistically significant differences of gender,age,BMI,positive rate of hypertension history,chronic obstructive pulmonary disease history or stroke history,SBP,DBP or heart rate was found between the two groups(P ﹥ 0. 05), while positive rate of diabetes of A group was statistically significantly lower than that of B group(P ﹤ 0. 05). No statistically significant differences of TC,TG,LDL-C,HDL-C or end - diastolic volume index was found between the two groups( P ﹥0. 05);FPG and HbA1c of A group was statistically significantly lower than that of B group,respectively end - systolic volume index was statistically significantly smaller than that of B group,LVEF and stroke volume of A group were statistically significantly higher than those of B group,Killip grading of A group was statistically significantly better than that of B group,while wall motion score index of A group was statistically significantly larger than that of B group( P ﹤ 0. 05). Multivariate logistic regression analysis results showed that,mean amplitude of glycemic excursions was one of risk factors of left ventricular function of patients with acute myocardial infarction〔 OR = 1. 567,95% CI(1. 021,2. 178),P ﹤ 0. 05 〕. Conclusion Glycemic excursions can affect the left ventricular function of patients with acute myocardial infarction,and mean amplitude of glycemic excursions is one of the risk factors of left ventricular function.