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目的:探讨不合并糖尿病的急性冠状动脉综合征(ACS)患者入院血糖水平与其远期预后的关系。方法:连续入选2014-01至2015-10期间承德医学院附属医院心内科住院的ACS并行经皮冠状动脉介入治疗(PCI)的患者585例,所有患者均不合并糖尿病。依据入院时血糖水平分为入院血糖≥7.0 mmol/L组(n=133)和入院血糖<7.0 mmol/L组(n=452)。收集所有入组患者的人口学特征、临床症状与治疗方案等资料,并进行随访评估预后。结果:中位随访时间350天,与入院血糖<7.0 mmol/L组相比,入院血糖≥7.0 mmol/L组患者的全因死亡率较高(2.4%vs 0.9%),但差异无统计学意义(P>0.05);入院血糖≥7.0 mmol/L组的主要不良心血管事件(MACE)发生率、PCI并发症、复发心绞痛、因心脏事件再入院率均高于血糖<7.0 mmol/L组(P均<0.05)。Cox比例风险预测模型显示,除了急性ST段抬高型心肌梗死(STEMI)、恶性心律失常和既往心肌梗死病史[危险比(HR)分别为2.106、3.028、2.293],入院血糖≥7.0 mmol/L也是ACS患者远期预后不良的独立危险因素(HR=1.998)。结论:对于不合并糖尿病的ACS患者,入院血糖≥7.0 mmol/L预示远期预后不良。
Objective: To investigate the relationship between blood glucose level and long-term prognosis in patients with acute coronary syndrome (ACS) without diabetes mellitus. Methods: A total of 585 ACS patients undergoing percutaneous coronary intervention (PCI) were enrolled in Department of Cardiology, Affiliated Hospital of Chengde Medical College from January 2014 to October 2015. All patients were without diabetes. According to the blood glucose level at admission, they were divided into seven groups: blood glucose≥7.0 mmol / L (n = 133) and admission glucose <7.0 mmol / L (n = 452). Demographic characteristics, clinical symptoms and treatment regimens of all enrolled patients were collected and evaluated for follow-up. Results: The median follow-up time was 350 days. All-cause mortality (2.4% vs 0.9%) was higher in patients with admission blood glucose> 7.0 mmol / L than those with admission glucose <7.0 mmol / L, but no difference was found (P> 0.05). The incidences of major adverse cardiovascular events (MACE), PCI complications, recurrent angina pectoris and rehospitalization rates due to cardiac events were all higher than those of blood glucose <7.0 mmol / L group (P <0.05). Cox proportional hazards prediction model showed that except for acute ST-elevation myocardial infarction (STEMI), malignant arrhythmia and previous myocardial infarction [hazard ratio (HR) were 2.106,3.028,2.293 respectively], blood glucose ≥7.0 mmol / L It is also an independent risk factor for long-term prognosis in patients with ACS (HR = 1.998). CONCLUSIONS: For ACS patients without DM, admission glucose ≥7.0 mmol / L predicts poor long-term prognosis.