摘要
目的·探讨应激性血糖升高比值(stress hyperglycemia ratio,SHR)在评价急性心肌梗死患者预后中的价值。方法·序贯入选2014年10月—2015年10月确诊为急性心肌梗死(acute myocardial infarction,AMI)患者434例,采集患者入院即刻血糖、糖化血红蛋白(glycosylated hemoglobin,HbA1c),计算SHR。根据AMI患者合并糖尿病的情况以及近、远期(2年)主要心脑血管事件的发生分组,比较上述指标与患者预后的关系,探究血糖及SHR数值对预测AMI患者转归的意义。结果·远期事件组AMI患者入院即刻血糖(P=0.003)、SHR(P=0.005)显著高于无事件组。合并糖尿病的AMI患者,在院事件组SHR数值显著高于无事件组患者(P=0.000);不合并糖尿病的AMI患者,远期事件组SHR数值(P=0.000)和入院即刻血糖(P=0.000)均高于无事件组。AMI患者无论是否合并糖尿病,全因死亡率在SHR数值(三分位)最高组均最高(P=0.047,P=0.007);以SHR中位数分组绘制生存曲线,糖尿病AMI患者在院事件率及非糖尿病患者远期事件率均存在显著差异(P=0.023,P=0.000)。结论·血糖应激性升高是导致AMI患者远期预后不良的危险因素;患者无论是否合并糖尿病,SHR数值对预测AMI患者近、远期不良预后比入院即刻血糖更有价值。
Objective · To explore the value of stress hyperglycemia ratio (SHR) in predicting the prognosis of patients with acute myocardial infarction(AMI). Methods · A total of 434 patients diagnosed as having AMI were enrolled from October 2014 to October 2015. Immediate blood glucose, glycosylated hemoglobin (HbA1c) and SHR of each subjects were collected and calculated. Patients with and without diabetes were divided into several groups according to the occurrence of in-hospital and 2-year major adverse cardiovascular and cerebrovascular events (MACCEs). Indicators above were evaluated to predict the prognosis of patients with AMI. Results · Immediate blood glucose (P=0.003) and SHR (P=0.005) were significantly higher in MACCEs group than those in 2-year MACCEs-free group. Among AMI patients with diabetes mellitus, SHR in hospital MACCEs group was significantly higher than that in MACCEs-free group (P=0.001). Among AMI patients without diabetes, values of immediate blood glucose (P=0.001) and SHR (P=0.001) were higher in 2-year MACCEs group than those in MACCEs-free group. All-cause mortality was the highest (P=0.047, P=0.007) in the highest SHR group (three-digit relationship), no matter with or without diabetes mellitus. AMI patients with and without diabetes were further divided into two groups according to the median of SHR. High SHR could better predict in hospital MACCEs rate in AMI patients with diabetes as well as 2-year MACCEs rate without diabetes (P=0.023, P=0.000). Conclusion · Abnormal stress hyperglycemia is a risk factor of long-term poor prognosis in AMI patients. The value of SHR is more valuable in predicting the poor prognosis of AMI than immediate blood glucose, no matter the patients with or without diabetes.
作者
夏智丽
高程洁
高亚洁
陶逸菁
万青
吴昊
魏钧伯
周翌
潘静薇
XIA Zhi-li;GAO Cheng-jie;GAO Ya-jie;TAO Yi-jing;WAN Qing;WU Hao;WEI Jun-bo;ZHOU Yi;PAN Jing-wei(Department of Cardiology , Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai 200233, China;Geriatrics Department , Shanghai Sixth People’sHospital, Shanghai Jiao Tong University, Shanghai 200233, China)
出处
《上海交通大学学报（医学版）》
CAS
CSCD
北大核心
2019年第3期309-315,共7页
Journal of Shanghai Jiao tong University:Medical Science
关键词
急性心肌梗死
应激性血糖升高比值
预后
acute myocardial infarction
stressed hyperglycemia ratio (SHR)
prognosis
