高血糖对非糖尿病急性心肌梗死患者心脏复极活动和预后的影响

发布时间：2018-05-18 20:14

本文选题：高血糖 + 急性心肌梗死　；参考：《中国老年学杂志》2016年22期

【摘要】：目的观察非糖尿病急性心肌梗死(AMI)患者的血糖水平与心脏复极活动的关系,并探讨其对预后的影响。方法根据急性期(1~3 d)的空腹血糖(FPG)水平,入选无糖尿病的AMI患者186例,分为对照组(5.6~7.8 mmol/L)和高糖组(7.8 mmol/L),比较两组患者的QT间期(QT)、校正后QT间期(QTc)、T波顶点到终点的时程(Tp Te)、QT间期Tp Te/QT和室性心律失常发生率的差异,运用相关性分析观察血糖和心脏复极的关系,并进行随访,比较两组患者终点事件(再发心梗、因心力衰竭入院和死亡)的差异,并用Cox回归分析观察血糖与预后的关系。结果与对照组比较,高糖组患者的QTc〔(434.7±22.5)ms vs(412.9±21.3)ms〕、Tp Te〔(86.2±5.6)ms vs(75.2±4.1)ms〕、Tp Te/QT〔(0.22±0.05)ms vs(0.19±0.04)ms〕显著延长(P0.05);频发室性期前收缩和室速发生率显著增加(P0.05),室颤发生率无显著差异(P0.05);血糖水平与复极时程呈中度相关(P0.05);平均随访(12.4±3.6)个月,生存分析显示高糖组患者终点事件发生率高于对照组(34.3%vs 20.2%,P=0.02),高血糖是预后的独立危险因素(OR 3.75,95%CI:2.87~5.25,P0.01)。结论高血糖严重影响非糖尿病AMI患者的心电活动和预后,降糖治疗有望改善患者的临床结局。
[Abstract]:Objective to investigate the relationship between blood glucose level and cardiac repolarization in patients with non-diabetic acute myocardial infarction (AMI). Methods according to the fasting blood glucose level of 3 days in the acute phase, 186 patients with AMI without diabetes mellitus were enrolled. The patients were divided into two groups: control group (5.6nmol / L) and high glucose group (7.8mmol / L). The QT interval (QT interval), the corrected QT interval and the time course from the top of QT interval to the end point of T wave, and the incidence of ventricular arrhythmias were compared between the two groups. The relationship between blood glucose and cardiac repolarization was observed by correlation analysis and followed up to compare the difference of end point events (recurrent myocardial infarction, hospitalization and death due to heart failure) between the two groups, and the relationship between blood glucose and prognosis was observed by Cox regression analysis. Results compared with the control group, In high glucose group, QTc((434.7 卤22.5)ms vs(412.9 卤21.3 QTc((434.7 Te((86.2 卤5.6)ms vs(75.2 卤4.1 Te((86.2 卤4.1 Te((86.2 卤4.1T Te/QT((0.22 卤0.05)ms vs(0.19 卤0.04 Ms) significantly prolonged P0.05, and the incidence of frequent premature ventricular contraction and ventricular tachycardia increased significantly (P0.05), and there was no significant difference in incidence of ventricular fibrillation (P0.05). The blood glucose level was moderate to that of repolarization process (P < 0.05), and the incidence of frequent ventricular premature contraction and ventricular tachycardia increased significantly (P < 0.05), but the incidence of ventricular fibrillation was not significantly different from that in hyperglycemia group. The average follow-up was 12.4 卤3.6 months. Survival analysis showed that the incidence of endpoint events in the high glucose group was higher than that in the control group (34. 3 vs 20. 2). Hyperglycemia was an independent risk factor for prognosis. Conclusion hyperglycemia seriously affects the ECG activity and prognosis of patients with non-diabetic AMI, and hypoglycemic therapy is expected to improve the clinical outcome of patients with non-diabetic AMI.
【作者单位】：华中科技大学同济医学院附属普爱医院ICU科;
【分类号】：R542.22

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