·糖尿病心血管病·

　　何泉 罗海明 杨建华

　　作者单位：650032昆明，云南省第一人民医院急诊科(何泉、罗海明);昆明医学院第二附属医院(杨建华)

　　【摘要】 目的 初步探讨入院血糖水平对急性冠脉综合征(ACS)近期预后的影响。 方法 将2007年1月至2010年10月ACS患者246例纳入研究，记录ACS患者基线时各指标，住院期间不良事件发生—主要心血管事件(MACE)和死亡情况，以及入院时的血糖值。按血糖水平进行分组，A组：2.8~6.9mmol/L，B组：7.0~11.09mmol/L, C组：>11.1mmol/L,组间比较临床情况和住院期间不良事件发生情况。以基线指标为自变量，住院期间不良事件发生率为因变量进行单因素分析和多元回归分析，探讨住院期间不良事件发生独立危险因素。 结果 246例ACS患者单因素相关分析显示影响不良事件发生即预后的变量分别是入院时血糖水平、心梗面积(用CK-MB值评估)、心梗范围(MIS)、ST段抬高ACS发生率、再梗死率、心率。各组比较，主要心血管事件发生率有显著性差异;多元回归分析显示，入院血糖水平等6个因素与住院期间不良事件发生相关，其次是入院其血糖水平、ST段抬高发生率、心梗范围、心梗面积、心率、再梗死率。 结论 入院血糖水平与ACS患者住院期间近期预后不良相关，入院血糖水平升高是ACS患者风险发生的标志。

　　【关键词】血糖;急性冠状动脉综合征;预后

　　doi:10.3969/j.issn.1006-6187.2011.08.006

　　Effects of admission blood glucose on the prognosis of acute coronary syndromes

　　HE Quan, LUO Hai-ming，

　　YANG Jian-hua. Department of Emergency, The first People Hospital of Yunnan Province, Kunming 650032, China

　　【Abstract】 Objective To investigate the value of admission glucose level for prognosis of acute coronary syndromes (ACS). Methods 246 cases with ACS were divided into three groups: A group (82 cases) with glucose level 2.8-6.9 mmol/L; B group (96 cases) with glucose 7.0-11.09 mmol/L and C group (68 cases) with glucose level>11.1 mmol/L at admission. The admission blood glucose (ABG), CK-MB, PP, HR, STEACS, myocardial infarction size (MIS) and rate of reinfarction were used as independent variable and mortality from all cause was used as dependent variable for multivariate stepwise regressive analysis. Results The HR, MIS, rate of STEACS, CK-MB and rate of reinfarction were significantly different between groups of A, B, and C. The independent risk factor for major cardiovascular events(MACE) were HR, CK-MB, admission blood glucose, ST-elevated ACS, MI-size and reinfarction after logistic stepwise regression. Conclusions Admission blood glucose appears to predict major cardiovascular events of patients with ACS.

　　【Key words】Admission blood glucose(ABG); Acute coronary syndrome; Prognosis