摘要
摘 要：目的 研究急性心肌梗死（acute myocardial infarction,AMI）合并糖尿病（diabetes mellitus,DM）患者的临床特征及住院病死率,分析影响AMI预后的危险因素.方法 收集天津医科大学第二医院2000到2004年1023例AMI患者的临床资料、治疗、并发症及预后.按是否合并DM,分为DM组与非DM组,其中DM患者164例（16.03%）,回顾性比较DM组与非DM组临床特征.计数资料采用χ~2检验,偏态分布的计量资料采用两独立样本秩和（Mann-Whitney U）检验,并对影响AMI住院病死率的因素进行多因素回归分析.结果 与非DM组相比,DM组女性较多（40.2%vs.28.9%,P〈0.01）,高血压和心绞痛患病率高（71.7%vs.41.6%,P〈0.01;57.3%vs.48.3%,P〈0.05）,入院时间延迟,住院期间易并发肺水肿（18.9%vs.10.5%,P〈0.01）,心律失常,冠状动脉三支病变率较高（48.4%vs.25.4%,P〈0.05）,治疗中利尿剂（43.9%vs.32%,P〈0.01）,洋地黄类药物（27.4%vs.16.8%,P〈0.01）使用率高,住院病死率约为非DM组的两倍（17.7%vs.9.2%,P〈0.01）.与保守治疗相比,急诊支架术可以降低DM患者病死率（χ~2=4.536,P〈0.05）.Logistic回归分析显示DM是AMI患者住院病死率的独立危险因子（OR,2.109;95%CI,1.229～3.619）.结论 AMI合并DM患者住院期间并发症多,住院病死率高.DM是AMI患者住院病死率的独立危险因子.
Objective To evaluate the clinical characteristics and in-hospital mortality of acute myocardial infarction patients （AMI） with diabetes mellitus （DM） and to analyze the risk factors of in-hospital mortality of AMI. Method A total of 1023 patients with diagnosis of AMI complicated with or without DM admitted between 2000 and 2004 were analyzed to find out the clinical characteristics, in-hospital complications and mortality. Of them, 164 （16.03%） were complicated with DM. The data were analyzed by using Mann-Whitney U or chi-square test. The multivariate logistic regression analysis was used to find out the risk factors of in-hospital mortality of patient with AMI. Results In comparison with non-DM patients, the females were predominant in number over males in the DM patient cohort （42.2% vs. 28.9%, P 〈 0.05）, the incidence of hypertension （71.7% vs. 41.6%, P 〈 0.01） and rate of angina （57.3% vs. 48.3%, P 〈 0.06）. The admission time of DM patients was delayed rather than that of non-DM patients. Coronary angiography revealed that the rate of three-vessel in-volved was higher in DM patients than in non-DM patients （48.4% vs. 25.4%, P 〈 0.05. During hospital stay, AMI patients with DM presented mar frequently with arrhythmias, pulmonary edema （18.9% vs. 10.5%, P 〈0.01） and increase in in-hospital mortality （17.7% vs. 9.2%, P 〈 0.01） compared with non-DM patients. Di-uretics （43.9% vs. 32%, P 〈0.01） and digitalis （27.4% vs. 16.8%, P 〈0.01） were more frequently used in DM patients rather than in non-DM patients. Compared to medication, primary coronary intervention （PCI） with placement of intra-vascular stent significantly decreased the mortality of DM patients （χ~2 = 4.536, P 〈 0.05）.Logistic regression analysis showed DM was an independent risk factor for in-hospital mortality （OR = 2.109;95% CI：1.229-3.619）. Conclusions AMI patients with DM exhibit more risk factors for in-hospital complications and higher mortality than those without DM.DM
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2010年第3期281-284,共4页
Chinese Journal of Emergency Medicine
关键词
心肌梗死
糖尿病
住院病死率
预后
调查与分析
Myocardial infarction
Diabetes mellitus
in-hospital mortality
Prognosis
Multiple factors analysis
