摘要
目的:探讨急性心肌梗死(AMI)急性期的空腹血糖水平与心室重构之间的相关性以及与1个月、1年死亡率的关系。方法:连续248例非糖尿病AMI患者,排除了其他引起慢性应激的因素,测定患者次日晨起空腹血糖(FG)。AMI后第2周进行超声心动图检查,随访患者1个月和1年的存活情况。进行FG和超声心动图各参数间的相关分析。比较不同血糖水平下的1个月和1年死亡率。结果:①FG与左室射血分数(r=-0.287,P<0.01),左室后壁厚度(r=-0.205,P<0.01)均呈轻度负相关,与左室舒张末径(r=0.166,P<0.05),左室收缩末径(r=0.312,P<0.01)均呈轻度正相关。②合并应激性高血糖者预后较无应激性高血糖者差(1个月死亡率:19.8%vs.7.5%,P<0.01;1年死亡率26.7%vs.12.2%,P<0.01)。血糖重度升高者预后较轻度升高者差(1个月死亡率:33.3%vs.13.2%,P<0.05;1年死亡率42.4%vs.19.1%,P<0.05)。结论:AMI急性期的FG水平作为机体应激程度的标志与左心室重构相关,FG高者,1个月和1年预后均较差。
Objective：To investigate the correlation between fasting glucose （FG） level in early phase of acute myocardial infarction （AMI） and ventricular remodeling as well as the association between FG and both 1-month and 1-year mortality. Methods： A total of 248 consecutive nondiabetic patients with AMI were studied. FG （Fasting〉 8 hours within 24 hours after admission） was measured in each patient. Echocardiographic parameters were obtained 2 weeks after admission. Linear correlation analysis was performed between FG and Left ventricular ejection （EF）, left atrial diameter （LA）, right ventricular diameter （RV）, diastolic left ventricular diameter （LVd）, systolic left ventricular diameter （LVs）, interseptal ventricular thickness （IVS） and left ventricular posterior wall thickness （LVPW）. Both 1-month and 1-year mortality were studied at different FG level. Results： （1） FG was negatively correlated with LVEF （r = -0. 287, P〈0. 01 ） and LVPW（r = -0. 205, P〈0. 01 ） and positively correlated with LVd （r= 0. 166,P〈0. 05） and LVs （r = 0. 312, P〈0. 01）, but it was not correlated with IVS, LA or RV （P〈 0. 05）. （2） Both 1-month （19. 8% vs. 7. 5%,P〈0. 01） and 1-year （26. 7% vs. 12. 2%% P〈0. 01） mortality was higher in patients with stress hyperglycaemia than those with normal FG. Compared with patients categorized as having mildly elevated FG, both 1-month （33. 3% vs. 13. 2% ,P〈0. 05） and 1-year（42. 4% vs. 19. 10% ,P〈0. 05） mortality was higher in patients with severely elevated FG. Conclusion： As a marker of the extent of physical stress, FG level in early phase of AMI is correlated with left ventricular remodling, and higher level of FG signifies worse prognosis at both 1 month and 1 year.
出处
《内科急危重症杂志》
2005年第6期261-263,269,共4页
Journal of Critical Care In Internal Medicine
关键词
急性心肌梗死
高血糖症
应激
心室重构
预后
acute myocardial infarction hyperglycaemia stress ventricular remodeling/orognosis
