高血糖对急诊 PCI 患者住院与随访预后的影响

摘要

目的：探讨接受直接经皮冠状动脉介入治疗（PCI）的急性ST段抬高心肌梗死（STEMI）患者，其高血糖水平对住院及长期随访预后影响。方法：入选我院诊断STEMI ，起病12h内行急诊PCI的患者218例，根据入院即刻血糖水平及口服葡萄糖耐量实验结果分为血糖正常组（108例）、高血糖组（60例）和糖尿病（DM）组（50例）。评估各组心功能指标，住院及随访1年预后；采用Logistic回归分析STEMI行急诊PCI者死亡率的影响因素。结果：与血糖正常组比较，糖尿病组住院死亡率（1.9％比10.0％）显著上升；高血糖组和糖尿病组女性2支以上血管病变（41.2％比68.8％比66.7％），植入2个以上支架（14.7％比50.0％比55.6％）比例显著升高（P＜0.05或＜0.01）；多因素Logistic回归分析显示， Killip分级、NT‐proBNP、病变血管数目和人体质量指数是这种患者住院病死率独立危险因素（OR＝1.012～5.923， P均＜0.05），女性是住院和1年内随访死亡率的强独立危险因素（OR＝20.376、7.227， P均＜0.01）。结论：急性ST段抬高心肌梗死伴高血糖行急诊 PCI术者死亡率明显升高，女性尤甚。%Objective:To explore influence of hyperglycemia on hospitalization and follow‐up prognosis in patients with acute ST elevation myocardial infarction (STEMI ) undergoing direct percutaneous coronary intervention (PCI) .Methods :A total of 218 patients ,who were diagnosed as STEMI and received emergency PCI within 12h af‐ter onset from our hospital ,were enrolled .According to blood glucose level at hospitalization and OGTT results , they were divided into normal blood glucose (NBG) group (n= 108) ,hyperglycemia group (n= 60) and diabetes mellitus (DM) group (n=50) .Cardiac function indexes were evaluated ;Logistic regression analysis was used to an‐alyze influencing factors for mortality in these patients .Results:Compared with NBG group , the in‐hospital mortal‐ity was significant rise (1.9% vs .10.0% ) in DM group ;there were significant rise in percentages of ≥double‐vessel coronary disease (41.2% vs .68.8% vs .66.7% ) and ≥2 stents implanted (14.72% vs .50.0% vs .55.6% ) in women in hyperglycemia group and DM group (P<0.05 or <0.01);Multi‐factor Logistic regression analysis indi‐cated that Killip class ,NT‐proBNP ,number of diseased vessels and body mass index were independent risk factors of in‐hospital mortality of these patients (OR=1.012~5.923 ,P<0.05 all) ,and female was a strong independent risk factor for in‐hospital mortality and mortality within one‐year follow‐up (OR=20.376 ,7.227 ,P<0.01 both) .Con‐clusion:The mortality significantly rises in STEMI patients undergoing emergency PCI complicated with hyperglyce‐mia ,especially in female patients .