目的 探讨入院血糖水平对非糖尿病和合并糖尿病的急性冠状动脉综合征(ACS)患者住院及长期死亡率的预测价值.方法 连续选择2008年7月-2010年12月入住北京友谊医院重症心血管病监护病房(CCU)的ACS患者1534例.其中符合入选标准的患者1332例,根据入院血糖不同水平将患者分组,分析各组患者住院期间及长期的全因死亡率.结果在非糖尿病患者中,入院血糖＜ 7.8 mmol/L组(A组)649例,7.8～ 11.1 mmol/L组(B组)203例,≥11.1 mmol/L组(C组)88例；在糖尿病患者中,A组124例,B组142例,C组126例.Cox回归分析显示,在非糖尿病患者中,高入院血糖(B组HR l.48,P=0.05;C组HR2.78,P＜0.001)是长期全因死亡率独立预测因子.在糖尿病患者中,入院血糖≥11.1 mmol/L是长期全因死亡率独立预测因子(HR 2.68,P＜0.001).结论 与糖尿病患者相比,无糖尿病史的ACS患者入院血糖水平升高也很常见,是住院及长期预后不良独立预测因素.%Objective To evaluate whether the predictive value of admission hyperglycemia for mortality differs between diabetics and non-diabetics with acute coronary syndrome (ACS).Methods A total of 1534 consecutive patients admitted with ACS to Central Control Unit of Beijing Friendship Hospital were analyzed.Among these patients,1332 patients who had a venous plasma glucose record at admission were retrospectively enrolled and were stratified according to admission glucose levels with or without diabetes.The primary end point was in-hospital and 2-year all-cause mortality.Results In patients without a history of diabetes,649 patients had glucose level ≤7.8 mmol/L(group A),204 patients with 7.8-11.0 mmol/L (group B) and 142 patients ＞ 11.0 mmol/L (group C).Of those with diabetes,124 patients were in group A,142 in group B and 126 in group C.By Cox regression analysis,admission hyperglycemia (group B,HR 1.48,P =0.05 ; group C,HR 2.78,P ＜ 0.001) was an independent predictor of long-term all-cause mortality in patients without diabetes.In patients with diabetes,blood glucose ＞ 11.0 mmol/L (group C,HR 2.68,P ＜ 0.001) also independently predicted long-term all-cause mortality.Conclusions Compared with the diabetic patients,elevation of blood glucose at admission is common in ACS patients without definite history of diabetes.Admission hyperglycemia should be considered as a risk factor strongly correlated with in-hospital and 2-year all-cause mortality in patients with ACS.
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