急性心肌梗死急性早期空腹高血糖与住院新发心房颤动的关系及其对预后的影响

摘要

目的:探讨急性心肌梗死(AMI)急性早期空腹高血糖与住院新发心房颤动(房颤)的关系及其对预后的影响.方法:AMI病例563例,按空腹血糖水平分空腹高血糖组(空腹血糖≥7 mmol/L,n=250)与对照组(空腹血糖<7 mmol/L,n=313),在不同的心功能Killip分级下比较两组房颤发生率的差异;分别比较两组中糖尿病与非糖尿病患者房颤发生率的差异.根据住院期间是否合并空腹高血糖或房颤,入选患者分既无高血糖亦无房颤亚组、合并高血糖亚组、合并房颤亚组、同时合并高血糖与房颤亚组4个亚组,比较4个亚组住院死亡率的差异.结果:在心功能Killip Ⅰ级、Ⅱ级时,空腹高血糖组房颤发生率明显高于对照组(16.4% vs 6.5%,P=0.005及21.4% vs 12.2%,P=0.037);在心功能Killip Ⅲ~Ⅳ级时两组房颤发生率差异无统计学意义(P=0.761).Logestic回归分析显示高血糖是AMI患者住院房颤发生的独立危险因素(OR=2.6,95%CI 1.59~4.30).无论空腹高血糖组还是对照组,糖尿病与非糖尿病患者房颤发生率差异均无统计学意义(P=0.436,0.441); 既无高血糖亦无房颤亚组住院死亡率0.4%,同时合并高血糖与房颤亚组住院死亡率31.5%,后者是前者的79倍.结论:AMI患者合并空腹高血糖住院期间房颤发生率增高,高血糖可能是房颤发生的独立危险因素,而与是否合并糖尿病无关;AMI同时合并空腹高血糖与房颤,住院死亡率进一步增高,预后不良.%Objective: To explore the relationship between early stage fasting glucose(FG) and new onsetof a trial fibrillation(AF) with their prognosis in patients of acute myocardial infarction( AMI).Methods:A total of 563 AM patients were divided into two groups, Fasting hyperglycemia groups = 250 , the patients had FG≥7 mmol/L and Control group, n = 313, FG<7 mmo/L The incidence ofnewAF onsetdurhghospitalizattonwas conpared between two groups under different cardiac function Killip levels According to the combination of hyperglycemia or AF, the patients were divided into another4 sub-groups as FG-AF-group( the patients had neitherhyperglycemia norAF,n = 284) , FG AF+ group, ( patients had AF,n = 29) , FG+AF-group, ( patients had hyperglycemia,n = 196) andFG+AF+ group, ( patients had both hyperglycemia andAF,n = 54). The in-hospitalmortalitywas analyzed anong4 groupsResults; In Killip levels I and II , the incidence of AF was higher in Fasting hyperglycemia group than that in Control grouf(16.4% vs6. 5%, P =0. 005 and21.4% vsl2. 2% , P =0.037) ; while in Killip levels IE to JV, the incidence of AF was smilar between two groups, P =0.761. Logistic regressbn analysis indicated thathyperglyceniawas an independent risk factor for AF in AMI patients during hospitalizattor( OR= 2. 6, 95% CI:1. 59-4. 30) . The irfeospital mortality in FG-AF-group was 0. 4% , in FG+AF+ group was31. 5% , the difference was79 timesConclusion:The early stage fasting hyperglycemia might be an independent risk factor forAF occurrence in AMI patients during theirhospitalization AMI patients combined with both hyperglycenia and AF had higher in-hospitalmortality and worse prognosis