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目的探讨急性高血糖对 ST 段抬高性心肌梗死(STEMI)患者院内预后的影响。方法连续入选356例北京地区17家三级和二级医院所有在24h 内入院且符合 STEMI 诊断标准的患者。以人院血糖水平>11mmol/L 判定为高血糖,分为高血糖组和血糖正常组,观察两组患者院内死亡和心血管病事件的发生情况。院内心血管事件定义为院内再发心肌梗死、新发生的心力衰竭、严重心律失常及卒中。结果 356例 STEMI 患者中,存在急性高血糖患者共81例(22.8%)。其院内病死率较无急性高血糖患者显著增加(13.6%比5.1%,P=0.009),院内心血管事件发生率亦显著增多(32.1%比20.4%,P=0.027)。logistic 回归分析示,入院急性高血糖(OR 1.615,95%CI 1.116～2.338,P=0.011)为 STEMI 患者院内不良预后的独立危险因素。结论 STEMI 急性高血糖患者院内死亡及发生院内心血管事件的危险性显著高于入院血糖正常者。入院高血糖为 STEMI 患者院内不良预后的独立危险因素。
Objective To investigate the effect of acute hyperglycemia on in-hospital prognosis in patients with ST-elevation myocardial infarction (STEMI). Methods A total of 356 patients with grade 3 and grade 2 hospitals in Beijing were enrolled and all were admitted within 24 hours and met the criteria of STEMI. Hypoglycemia was determined by the blood glucose level> 11mmol / L in the hospital and divided into hyperglycemia group and normal blood glucose group. The in-hospital mortality and cardiovascular events were observed in both groups. In-hospital cardiovascular events were defined as recurrent hospital-acquired myocardial infarction, new-onset heart failure, severe arrhythmia, and stroke. Results Of the 356 STEMI patients, there were 81 patients (22.8%) with acute hyperglycemia. The hospital mortality was significantly higher than that of patients without acute hyperglycemia (13.6% vs 5.1%, P = 0.009). The incidence of cardiovascular events in hospital also increased significantly (32.1% vs. 20.4%, P = 0.027). Logistic regression analysis showed that admission of acute hyperglycemia (OR 1.615, 95% CI 1.116-2.338, P = 0.011) was an independent risk factor for nosocomial poor prognosis in patients with STEMI. Conclusion STEMI patients with acute hyperglycemia in hospital mortality and the risk of cardiovascular events were significantly higher than those with normal blood glucose. Admission of hyperglycemia was an independent risk factor for poor prognosis in STEMI patients.