摘要
目的研究糖代谢紊乱对急性心肌梗死(acute myocardial infarction,AMI)患者院内主要不良心血管事件的影响。方法回顾性分析2019年1月1日至2020年12月31日首都医科大学宣武医院收治的997例AMI患者的临床资料,依据既往糖尿病病史、入院糖化血红蛋白(hemoglobin A1c,HbA1c)和入院48h内的空腹血糖(fasting plasma glucose,FPG)水平分为四组:入院前已确诊糖尿病的331例患者为既往糖尿病组;既往无糖尿病史,入院时血糖高于正常范围且达到糖尿病诊断标准(即FPG≥7.0mmol/L和/或HbA1c≥6.5%)的170例患者为新诊断糖尿病组;既往无糖尿病史,入院时血糖高于正常范围,但未达到糖尿病诊断标准(即6.1mmol/L≤FPG<7.0mmol/L和/或5.7%≤HbA1c<6.5%)的253例患者为糖尿病前期组;既往无糖尿病史,且入院时血糖在正常范围(2.8mmol/L<FPG<6.1mmol/L且HbA_(1c)<5.7%)的243例患者为正常对照组。比较四组患者的基本临床资料以及院内主要不良心血管事件(major adverse cardiovascular events,MACE)发生情况。采用二元logistic回归分析比较不同糖代谢状态与院内MACE的相关性。结果与正常对照组比较,既往糖尿病组、新诊断糖尿病组、糖尿病前期组男性比例低,年龄大,甘油三酯水平较高,心功能较差,差异有显著性(P<0.05)。与正常对照组比较,既往糖尿病组和新诊断糖尿病组既往发生心肌梗死及进行血运重建的患者比例高,左心室射血分数较低,院内行冠状动脉旁路移植术的比例高,差异有显著性(P<0.05)。多因素分析结果显示,AMI患者存在糖代谢紊乱(既往糖尿病、新诊断糖尿病、糖尿病前期)时院内MACE及心力衰竭发生风险显著升高,新诊断糖尿病患者院内MACE及心力衰竭发生风险最高,且新发心房颤动风险显著升高。结论糖代谢紊乱是AMI患者住院期间发生MACE及心力衰竭的独立危险因素,而新诊断糖尿病是其住院期间新发心房颤动的独立危险因素。
Objective The purpose of this paper is to study the impact of glucose metabolism disorder on in-hospital major adverse cardiovascular events in patients with acute myocardial infarction(AMI).Method In this retrospective study,a total of 997 patients with AMI in Xuanwu Hospital Capital Medical University from January 1,2019 to December 31,2020 were included.According to their history of diabetes,hemoglobin A1c(HbA1c)and fasting plasma glucose(FPG)within 48 hours of admission,they were divided into four groups.331 patients who had been diagnosed with diabetes before admission were the previous diabetes group;170 patients who had no previous history of diabetes,whose blood sugar was higher than the normal range and reached the diagnostic criteria for diabetes(FPG≥7.0mmol/L and/or HbA1c≥6.5%)were newly diagnosed diabetes group;253 patients who had no previous history of diabetes,whose blood sugar was higher than the normal range,but did not meet the diagnostic criteria for diabetes(6.1mmol/L≤FPG<7.0mmol/L and/or 5.7%≤HbA_(1c)<6.5%)were in the pre-diabetes group;243 patients with no previous history of diabetes and normal blood glucose(2.8mmol/L<FPG<6.1mmol/L and HbA1c<5.7%)were in the normal control group.Compare the basic clinical data and the incidence of in-hospital MACE of four groups.Binary logistic regression was performed to examine the association between different glucose metabolism and in-hospital MACE.Result Compared with the normal control group,the previous diabetes group,the newly diagnosed diabetes group,and the pre-diabetes group had lower male proportion,older age,higher triglyceride level,and poor cardiac function.The difference is significant(P<0.05).Compared with the normal control group,the previous diabetes group and the newly diagnosed diabetes group had a higher proportion of patients with myocardial infarction and blood supply reconstruction,a lower left ventricular ejection fraction,and a higher proportion of patients with coronary artery bypass grafting in hospital.The difference is significant(P<0.05).Multivariate analysis shows that the risk of hospital MACE and heart failure in AMI patients with glucose metabolism disorder(previous diabetes,newly diagnosed diabetes,pre-diabetes)was significantly increased,especially when newly diagnosed diabetes was combined,the risk of hospital MACE and heart failure was the highest,and the risk of newly diagnosed atrial fibrillation was significantly increased when newly diagnosed diabetes was combined.Conclusion The disorder of glucose metabolism(previous diabetes,newly diagnosed diabetes,pre-diabetes)is an independent risk factor for MACE and heart failure in hospital,and newly diagnosed diabetes is an independent risk factor for new atrial fibrillation in hospital.
作者
刘亚云
夏经钢
Liu Yayun;Xia Jinggang(Department of Cardiology,Xuanwu Hospital,Capital Medical University,National Clinical Research Center for Geriatric Diseases,Beijing 100053,China)
出处
《中国医刊》
CAS
2023年第6期618-622,共5页
Chinese Journal of Medicine
基金
国家自然科学基金面上项目(81770344)。
关键词
急性心肌梗死
糖尿病
糖代谢紊乱
主要不良心血管事件
Acute myocardial infarction
Diabetes mellitus
Glucose metabolism disorder
Major adverse cardiovascular events
