胰岛素强化降糖治疗对急性冠脉综合征伴高血糖患者C反应蛋白和心功能影响的研究

摘要

目的：探讨胰岛素强化降糖方案对急性冠脉综合征（ACS）伴高血糖患者C反应蛋白和心功能的影响。方法选择2011年10月～2012年12月就诊的ACS患者220例，符合ACS发生24 h内入心脏监护室，所有患者随机血浆葡萄糖＞7.8 mmol/L（抽血前2 h内无进食，无静脉输注葡萄糖）。所有患者随机分至两组，每组110例，并分别采用不同的治疗方案，其中一组采用强化胰岛素治疗（强化组），另一组采用常规胰岛素治疗（常规组）。两组患者均使用相同的常规药物进行ACS的治疗。比较分析两组患者治疗前及治疗后的糖化血红蛋白HbA1c和C反应蛋白（CRP），同时对两组患者的血清N末端B型钠尿肽前体（NT-proBNP）、左心室射血分数和左心室舒张末期内径进行检测以观察患者的心功能改善情况。结果两组患者治疗后在降糖、C反应蛋白和心功能三方面均得到明显改善（P＜0.05），且强化组的改善程度明显优于常规组，差异有统计学意义（P＜0.05）。结论胰岛素强化降糖治疗可显著改善ACS伴高血糖患者的心功能，其机制可能与降低C反应蛋白有关。%Objective To investigate the hypoglycemic effect and cardiac function improvement effect of the intensive insulin hypoglycemic therapy in acute coronary syndrome(ACS) patients with hyperglycemia.Methods 220 ACS patients with hyperglycemia diagnosed and accepted into the CCU within 24 hours in our hospital from October 2011 to December 2012 were selected. Random plasma glucose of patients were>7.8 mmol/L(there were no eating and intravenous glucose infusion 2 h before blooding). All patients were randomly divided into two groups and were adopted different therapeutic methods, one group received intensive insulin hypoglycemic therapy group(110 cases), and the other group received conventional insulin treatment group(110 cases). Two groups of patients were dealt with same conventional ACS drug treatment. Glycated hemoglobin HbA1c, C reactive protein(CRP) in two groups were detected. Then compared and analyzed the indexes before and after treatment. Serum N terminal B type natriuretic peptide precursor(NT-proBNP), left ventricular ejection fraction and left ventricular end diastolic diameter were detected to estimate the improvement status of cardiac function.Results Hypoglycemic action, C reactive protein and cardiac function status in two groups were significantly improved after treatment(P<0.05), improvement extent in intensive insulin therapy group were significantly better than conventional insulin treatment group. The difference was significant(P<0.05).Conclusion Insulin intensive hypoglycemic therapy can significantly improve the cardiac function of ACS patients with hyperglycemia, and it may be associated with the decrease of C reactive protein.