血糖水平对非糖尿病心梗患者 PCI 后无复流及预后的影响

摘要

Objective:To explore the influence of different blood glucose level at hospitalization on no-reflow and prognosis in patients with acute myocardial infarction (AMI),but without diabetes after emergency percutaneous coronary intervention (PCI).Methods:A total of 678 non-diabetic AMI patients undergoing PCI were selected.Ac-cording to blood glucose level at hospitalization,patients were divided into normal group (n=312),blood glucose level higher group (higher group ,n=201)and blood glucose level extremely high group (extremely high group,n=165).Clinical characteristics,no-reflow after PCI and incidence of cardiovascular events within 30d after PCI were compared among three groups.Results:Compared with normal group and higher group,there were significant rise in age,percentages of >1 location of myocardial infarction and Killip's ≥ class II,white blood cell count instant af-ter hospitalization,peak value of creatine kinase (CK)and CK-isoenzyme (CK-MB)in extremely high group,P <0.01 all;Compared with normal group,the age,peak value of CK and CK-MB significantly rose in higher group (P<0.01 all).Along with blood glucose rose,incidence rate of no-reflow significantly increased (17.0% vs.38.8%vs.49.7%),left ventricular ejection fraction (LVEF)on 30d after PCI gradually reduced [(68.6± 5.7)% vs. (62.2±6.4)% vs.(55.6±6.9)%]in above-mentioned 3 groups in turn,there was significant difference between any two groups,P <0.05 or <0.01.Conclusion:Stress hyperglycemia possesses great influence on no-reflow and prognosis in non-diabetic AMI patients after PCI.%目的：探讨非糖尿病的急性心梗（AMI）患者不同入院血糖水平对急诊冠状动脉介入术（PCI）后无复流及预后的影响。方法：选择678例行 PCI 治疗的非糖尿病 AMI 患者，根据入院血糖水平分为正常组（312例）、血糖偏高组（201例）、血糖极高组（165例），比较三组临床特征及 PCI 术后无复流、术后30d 内心血管事件发生情况。结果：与正常组和血糖偏高组比较，血糖极高组的年龄较大，＞1个部位心肌梗死的比例、Killip’s 分级≥II 级比例、入院即刻白细胞计数、肌酸激酶（CK）峰值、肌酸激酶同工酶（CK-MB）峰值均显著升高（P ＜0.01）；与血糖正常组比较，血糖偏高组的年龄、CK 峰值、CK-MB 峰值均显著升高（P 均＜0.01）；随着血糖水平升高，上述3组的无复流发生率依次显著升高（17.0％比38.8％比49.7％），PCI 术后30 d 左室射血分数（LVEF）水平依次逐渐降低[（68.6±5.7）％比（62.2±6.4）％比（55.6±6.9）％]，两两间比较均有显著差异（P ＜0.05或＜0.01）。结论：应激性血糖水平升高会对非糖尿病的急性心梗（AMI）患者 PCI 术后无复流及预后形成较大影响。