基金项目：北京市保健专项基金资助项目(京09-08)

　　作者单位：100029首都医科大学附属北京安贞医院特需医疗科(米树华、苏工、陶红、郑虹、杨红霞)，急诊科(李昭)

　　通讯作者：苏工，E-mail：sg-15@sohu.com

　　米树华 苏工 陶红 李昭 郑虹 杨红霞

　　【摘要】 目的 探讨糖尿病合并急性心肌梗死(AMI)患者住院期间血糖波动的变化及意义。 方法 以性别、年龄及HbA1c水平进行1∶1配对的糖尿病合并AMI患者(AMI组)和糖尿病合并稳定性冠心病患者(CAD组)各30例，通过动态血糖监测技术获得患者住院期间血糖波动参数并比较。 结果 (1)AMI组与CAD组比，日内平均血糖波动幅度[MAGE，(3.83±1.38) vs (3.17±1.14) mmol/L]、日间血糖平均绝对差[MODD, (2.62±1.08) vs (2.00±0.90) mmol/L]、餐后血糖波动幅度[PPGE, (3.43±1.70) vs (2.34±1.64) mmol/L]和餐后3 h平均血糖水平[3 h MPBG,(10.49±2.44) vs (8.95±2.45) mmol/L]均升高(P<0.05)，平均血糖标准差有升高趋势[SDBG, (2.53±1.02) vs (2.16±0.85) mmol/L，P=0.051]。(2)多因素逐步回归分析显示AMI组中MAGE是独立于射血分数和年龄影响全球急性冠状动脉事件(GRACE)积分的危险因子。 结论 糖尿病合并冠心病患者发生AMI时，其住院期间的日内、日间和餐后血糖波动幅度均明显增大，MAGE还可能有助于评估患者的预后。

　　【关键词】急性心肌梗死;糖尿病;血糖波动

　　doi:10.3969/j.issn.1006-6187.2011.11.010

　　Changes of glycemic excursions in diabetic inpatients with acute myocardial infarction and relative clinical significances

　　MI Shu-hua，SU Gong，TAO Hong，et al. Department of Comprehensive Medicine，Beijing Anzhen Hospital of the Capital University of Medical Science，Beijing 100029，China

　　Corresponding author：SU Gong, E-mail: sg-15@sohu.com

　　【Abstract】 Objective To explore the change and its clinical significance of glycemic excursions in diabetic inpatients (DM) with acute myocardial infarction (AMI). Methods 30 DM patients with AMI(AMI group) and 30 DM patients with chronic coronary artery disease(CAD group) were enrolled with 30 health subjects matched for age，sex and HbA1c levels. All participants’ glycemic excursions were measured by a continuous glucose monitoring system for 72 hours. Results (1) The mean amplitude of glycemic excursions (MAGE)，absolute means of daily differences，postprandial glucose excursion and mean level of 3 hours postprandial blood glucose were higher in AMI patients[(3.83±1.38)，(2.62±1.08)，(3.43±1.70)，(10.49±2.44) mmol/L] than in CAD patients [(3.17±1.14)，(2.00±0.90)，(2.34±1.64)，(8.95±2.45)mmol/L，all P<0.05]. The standard division of blood glucose seems to be more in AMI patients than in others[(2.53±1.02) vs (2.16±0.85) mmol/L，P=0.051]. (2) Multiple stepwise regression analysis showed that MAGE in the AMI group was an impact factor of GRACE risk score，which was independent of age and EF value. Conclusion DM patients with AMI have a series of increased fluctuation in intraday，day-to-day and postprandial blood glucose excursions as compared to DM patients with CAD. The MAGE may be useful for evaluating the prognosis of DM patients with AMI.

　　【Key words】 Acute myocardial infarction;Diabetic mellitus;Glucose excursion