目的：了解急性心肌梗死患者的糖代谢状态,观察糖代谢异常急性心肌梗死患者行急诊经皮冠状动脉介入治疗后脂联素水平的变化。方法连续入选2010年7月至2011年9月首都医科大学附属北京友谊医院心血管中心住院治疗的首次急性心肌梗死患者共206例。对无糖尿病病史的患者住院期间行口服葡萄糖耐量试验,根据检查结果及既往有无糖尿病病史分为正常糖耐量、糖调节受损与糖尿病3组。分别于PCI手术前后、发病24、48、72 h、7 d检测脂联素水平,观察其变化趋势。结果(1)58例(28.2%)患者入院前已确诊为2型糖尿病,无糖尿病病史的患者中46.6%的患者为糖调节异常,10.8%新诊断为2型糖尿病,全部病例中69.4%的患者合并糖代谢异常。(2)糖代谢异常组患者的即刻血糖[(11.50±4.40)mmol/L、(8.22±1.38)mmol/L比(6.42±0.86)mmol/L]、空腹血糖水平[(9.23±4.11)mmol/L、(6.37±1.81)mmol/L比(5.19±0.79)mmol/L]均显著高于正常糖耐量组(均为P﹤0.05)；糖尿病组的左心室射血分数明显低于其他两组(51.82%±7.02%比54.70%±7.98%、54.75%±7.72%,均为P﹤0.05)；糖尿病组在PCI手术前后、发病后48、72 h与7 d脂联素水平均较正常糖耐量组低[(13.42±1.73)μg/ml比(15.37±1.73)μg/ml、(12.92±2.45)μg/ml比(14.71±1.61)μg/ml、(11.32±3.37)μg/ml比(12.48±2.64)μg/ml、(11.55±3.05)μg/ml比(13.13±2.55)μg/ml、(11.89±2.92)μg/ml比(13.56±2.36)μg/ml,均为P﹤0.05],糖尿病组在PCI手术前后、发病后72 h与7 d脂联素水平均低于糖调节受损组[(13.42±1.73)μg/ml比(15.61±1.60)μg/ml、(12.92±2.45)μg/ml 比(14.76±1.65)μg/ml、(11.55±3.05)μg/ml 比(12.61±2.13)μg/ml、(11.89±2.92)μg/ml比(13.18±2.04)μg/ml,均为P﹤0.05]；各组PCI术后脂联素水平均较术前降低(均为P﹤0.05)。结论糖尿病的急性心肌梗死患者脂联素水平低于正常糖耐量组和糖调节受损组的患者；正常糖耐量组、糖调节受损组及糖尿病组PCI术后脂联素水平均较术前显著降低,于发病后24 h各组脂联素水平降至最低值,随后逐渐回升。%Objective To characterize the glucometabolic state of patients with acute myocardial infarction ( AMI) ,and to investigate the influence of abnormal glycometabolism on adiponectin levels after the first acute myocardial infarction treated with primary percutaneuos coronary intervention. Methods Two hundred and six consecutive patients with ST-elevated myocardial infarction ( STEMI) in Beijing Friendship hospital were enrolled from July 2010 to August 2011. Patients with non-diagnosed diabetes were performed oral glucose tolerance test ( OGTT ) . Patients with AMI were divided into three groups according to glucometabolic state:NGT( normal glucose tolerance) , IGR( impaired glucose regulation) and DM( Diabetes Mellitus) . Blood samples were drawn before the invasive procedure, immediately after the invasive procedure, and at 24, 48, 72 h and 7days after AMI onset. Left ventricular end-diastolic diameter ( LVEDD ) and left ventricular ejection fraction ( LVEF ) were measured in all patients. Results ( 1 ) 28. 2% patients had known type 2 diabetes mellitus before AMI. Of patients with no diabetes, 46. 6% had impaired glucose regulation ( IGR) and 10. 8% had newly diagnosed diabetes. Of all patients with AMI, 79. 4% had abnormal glycometabolism. (2) Compared with NGT and IGT group, the fasting blood glucose [(9. 23 ± 4. 11)mmol/L,(6. 37 ± 1. 81) mmol/L vs. (5. 19 ± 0. 79) mmol/L, all P ﹤0. 05] and blood glucose immediately (11. 50 ± 4. 40,8. 22 ± 1. 38 vs. 6. 42 ± 0. 86,all P﹤0. 05) at admission in DM group were significantly higher. LVEF of DM group was significantly lower than other groups ( 51. 82% ± 7. 02%vs. 54. 70% ± 7. 98%,54. 75% ± 7. 72%,all P﹤0. 05). Plasma adiponectin level in DM group before the invasive procedure, immediately after the invasive procedure, and at 48, 72 h and 7 days after AMI onset were lower than NGT group [(13. 42 ± 1. 73) μg/ml vs. (15. 37 ± 1. 73) μg/ml,(12. 92 ± 2. 45) μg/ml vs. (14. 71 ± 1. 61) μg/ml,(11. 32 ± 3. 37) μg/ml vs. (12. 48 ± 2. 64) μg/ml,(11. 55 ± 3. 05) μg/ml vs. (13. 13 ± 2. 55) μg/ml,(11. 89 ± 2. 92) μg/ml vs. (13. 56 ± 2. 36) μg/ml,all P﹤0. 05]. Plasma adiponectin level in DM group before the invasive procedure, immediately after the invasive procedure and 72 h and 7 days after AMI onset were lower than in IGT group[(13. 42 ± 1. 73) μg/ml vs. (15. 61 ± 1. 60)μg/ml,(12. 92 ± 2. 45) μg/ml vs. (14. 76 ± 1. 65) μg/ml,(11. 55 ± 3. 05) μg/ml vs. (12. 61 ± 2. 13)μg/ml,(11. 89 ± 2. 92) μg/ml vs. (13. 18 ± 2. 04) μg/ml,all P﹤0. 05]. Conclusions Compared with NGT and IGR groups, adiponectin in DM group is significantly lower. Plasma adiponectin levels after the invasive procedure in NGT, IGR and DM groups are significantly lower than before the invasive procedure. Plasma adiponectin is decreased to the lowest level at 24 h after AMI onset in NGT, IGR and DM patients.
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