摘要
目的:通过对单中心大样本急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)后住院期间结果的分析,探讨患者入院时高血糖对住院期间心血管事件的影响。方法:连续入选自2013年1月至2013年12月期间中国医学科学院阜外医院10724例PCI患者,排除入院24小时内未测空腹血糖患者228例,排除稳定性心绞痛和无症状心肌缺血患者4210例,最终纳入ACS患者共6286例。根据患者入院血糖水平分为正常血糖组(空腹血糖<7.0 mmol/L,n=4872)和高血糖组(空腹血糖≥7.0 mmol/L,n=1414)。比较两组患者的临床特点,分析高血糖对住院期间主要不良心脑血管事件(MACCE)的影响。结果:(1)基线资料比较:正常血糖组有15.8%患有糖尿病,空腹血糖水平为(5.33±0.70)mmol/L,糖化血红蛋白水平(6.17±0.72)%;高血糖组有73.8%患有糖尿病,空腹血糖水平为(9.47±2.57)mmol/L,糖化血红蛋白水平(8.12±1.57)%。冠心病危险因素及既往病史方面:与正常血糖组相比,高血糖组患有高血压的比例(67.4%vs.62.5%,P<0.001)、高脂血症的比例(70.2%vs.64.4%,P<0.001)、既往有PCI史的比例(30.6%vs.19.3%,P<0.001)均较高。冠状动脉病变比较:三支病变的比例高血糖组高于正常血糖组(46.7%vs.38.2%,P<0.001)。入院病情比较:急性心肌梗死的比例高血糖组高于正常血糖组(39.7%vs.27.0%,P<0.001)。(2)住院期间MACCE发生率比较:与正常血糖组相比,高血糖组的住院期间全因死亡率和心原性死亡率均较高(0.5%vs.0.1%,P=0.007;0.4%vs.0.1%,P=0.021),高血糖组的MACCE发生率高于正常血糖组(2.1%vs.1.4%,P=0.045),差异均有统计学意义。(3)Logistic多因素回归分析显示,高血糖是住院期间全因死亡和心原性死亡的独立危险因素(OR=4.176,95%CI:1.062~16.426,P=0.041;OR=5.068,95%CI:1.176~21.834,P=0.029)。结论:入院时高血糖的ACS患者的住院期间全因死亡率、心原性死亡率、MACCE发生率增高。高血糖是住院期间全因死亡和心原性死亡的独立危险因素。
Objectives:To investigate the impact of fasting blood sugar level at admission on cardiovascular events during hospitalization in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods:ACS patients,hospitalized in Fuwai Hospital of Chinese Academy of Medical Sciences and received PCI from January to December 2013,were divided into normal fasting blood sugar group(fasting blood sugar at admission<7.0 mmol/L)and hyperglycemia group(fasting blood sugar at admission≥7.0 mmol/L).The clinical characteristics of the 2 groups were compared,and the impact of hyperglycemia on cardiovascular events during hospitalization was analyzed.Results:(1)Of the 10724 PCI patients,228 patients were excluded due to unavailable fasting blood sugar value within 24 hours after hospitalization.A total of 6286 ACS patients were included in this analysis(4872 normal blood sugar patients and 1414 hyperglycemia patients).15.8%patients of the normal blood sugar group had diabetes mellitus,the blood sugar level was(5.33±0.70)mmol/L,the glycosylated hemoglobin level was(6.17±0.72)%.The average blood sugar level in the hyperglycemia group was(9.47±2.57)mmol/L,the glycosylated hemoglobin level was(8.12±1.57)%,and the prevalence of diabetes mellitus in the hyperglycemia group was 73.8%.Compared with normal fasting blood sugar group,patients in hyperglycemia group had a higher proportion of hypertension(67.4%vs.62.5%,P<0.001),a higher proportion of hyperlipidemia(70.2%vs.64.4%,P<0.001),and a higher proportion of previous PCI history(30.6%vs.19.3%,P<0.001).The proportion of three vessel lesions(46.7%vs.38.2%,P<0.001)and acute myocardial infarction(39.7%vs.27.0%,P<0.001)were significantly higher in hyperglycemia group than in normal blood sugar group.(2)During hospitalization,the mortality was significantly higher in hyperglycemia group than in normal blood sugar group(0.5%vs.0.1%,P=0.007),the incidence of cardiogenic death(0.4%vs.0.1%,P=0.021),and MACCE was also higher(2.1%vs.1.4%,P=0.045)in hyperglycemia group than in normal blood sugar group.(3)Multivariate logistic analysis showed that hyperglycemia was an independent risk factor for all-cause and cardiac death during hospitalization(OR=4.176,95%CI:1.062-16.426,P=0.041;OR=5.068,95%CI:1.176-21.834,P=0.029)in this patient cohort.Conclusions:Compared with the normal fasting blood sugar group,incidences of all-cause mortality,cardiogenic mortality and MACCE are significantly higher in patients with hyperglycemia at admission.Hyperglycemia is an independent risk factor for all-cause and cardiac death during hospitalization in ACS patients post PCI.
作者
许连军
宋莹
许晶晶
高展
唐晓芳
王欢欢
刘如
蒋萍
姜琳
高立建
张茵
宋雷
赵雪燕
陈珏
高润霖
乔树宾
杨跃进
陈纪林
徐波
袁晋青
XU Lianjun;SONG Ying;XU Jingjing;GAO Zhan;TANG Xiaofang;WANG Huanhuan;LIU Ru;JIANG Ping;JIANG Lin;GAO Lijian;ZHANG Yin;SONG Lei;ZHAO Xueyan;CHEN Jue;GAO Runlin;QIAO Shubin;YANG Yuejin;CHEN Jilin;XU Bo;YUAN Jinqing(Coronary Heart Disease Center,National Center for Cardiovascualr Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)
出处
《中国循环杂志》
CSCD
北大核心
2020年第12期1187-1191,共5页
Chinese Circulation Journal
基金
国家重点研发计划项目(2016YFC1301301)。
关键词
经皮冠状动脉介入治疗
高血糖
糖尿病
血糖变异性
percutaneous coronary intervention
hyperglycemia
diabetes mellitus
glycemic variability
