摘要
目的探讨胰岛素治疗对急性ST段抬高型心肌梗死（ASTEMI）伴应激性高血糖患者近期预后的影响。方法将128例ASTEMI伴应激性高血糖患者随机分为治疗组和对照组各64例，均给予抗凝、抗血小板、他汀类、β受体阻滞剂、硝酸酯类药物和血管紧张素转化酶抑制剂（ACEI）或血管紧张素受体拮抗剂（ARB）治疗，治疗组在此基础上给予50U胰岛素（选用诺和灵R）加入50ml生理盐水中静脉泵入。分别在治疗前和治疗后第7天抽取静脉血，测定空腹血糖、超敏C反应蛋白（hs-CRP），并比较两组的近期预后情况。结果治疗组治疗后空腹血糖较治疗前显著下降[（5．4±0．8）、（11．6±2．3）mmol／L，t=13．97，P〈0．01]，而对照组无明显变化[（10．7±2．1）、（11．2±2．7）mmol／L，t=1．79，P〉0．05]。两组患者的hs—CRP均较治疗前显著下降：治疗组（6．2±1．5）、（12．8±2．4）mg／L，t=14．26；对照组（8．7±1．8）、（13．1±2．6）mg／L，t=10．97，P均〈0．01]。两组治疗后空腹血糖、hs—CRP比较，差异均有统计学意义（t值分别为-9．78、-0．37，P均〈0．01）。随访3个月，治疗组患者主要不良心脏事件发生率低于对照组[12．50％（8／64）与34．38％（22／64），χ^2=5．02，P〈0.05]。结论胰岛素治疗能改善ASTEMI伴应激性高血糖患者的近期预后。
Objective To observe the influence of insulin therapy on the short-term prognosis of patients with： acute ST-elevation myocardial infarction （ASTEMI） complicated with hyperglycaemia. Methods A total of 128 patients with ASTEMI complicated with hyperglycaemia were randomized into 2 groups：treatment group and control group. There were 64 patients （50.0%）in the treatment group and 64 patients （50. 0% ） in the control group. All of the patients were given anticoagulants, antiplatelet drugs, statins, beta-receptor blockers, nitrates and angiotensin-converting enzyme inhibitors （ACEI） or angiotensin receptor blocker （ARB） . Moreover,the patients in the treatment group were given extra 50 U insulin （ Novolin R） in 50 ml saline by venous infusion. In the treatment group, Venous blood samples were obtained before and 7 days after treatment to determine the fasting blood glucose and hs-CRP in＇ serum ; the levels of fasting blood glucose and hs-CRP and short-term prognosis were compared between the 2 groups. Results The levels of fasting blood glucose in the treatment group were decreased significantly after treatment （ [ 5.4 ± 0. 8 ] mmol/L vs [ 11.6 ± 2. 3 ] mmol/L, P 〈0. 01 ） ,but there was no significant change in the control group （ [ 10. 7 ± 2. 1 ] mmol/L vs [ 11.2 ± 2. 7 ] mmol/L,P 〉 0.05）. The levels of hs-CRP in both groups were decreased significantly after treatment（ P 〈 0. 05）, but it was much more obvious in the treatment group （ [ 6. 2 ± 1.5 ] mg/L vs [ 8.7 ± 1.8 ] mg/L, P 〈 0.05）. The incidence of major adverse cardiac events （MACE） during a 3 months＇ follow-up in the treatment group was significantly lower than that in the control group （ 12. 50% vs 34. 38%, P 〈 0. 05 ）. Conclusion Insulin therapy can improve the short-term prognosis in patients with ASTEMI complicated with hyperglycaemia.
出处
《中国综合临床》
2012年第1期19-21,共3页
Clinical Medicine of China
关键词
心肌梗死
应激性高血糖
C反应蛋白
主要不良心脏事件
Myocardial infarction
Stress-induced hyperglycaemia
C reactive protein
Major adverse cardiac events
