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心不全で入院した高齢患者の高血糖値と死亡率
Mikhail Kosiborod1, Silvio E Inzucchi, John A Spertus
1Mid America Heart Institute of Saint Luke's Hospital, Kansas City, MO 64111, USA. mkosiborod@cc-pc.com
Circulation
|April 1, 2009
まとめ
心不全患者の高血糖は,死亡リスクを有意に増加させない. この研究では,入院した心不全患者の血糖値上昇と死亡との関連は認められず,既存のガイドラインに異議を唱えた.
科学分野:
- 心臓病学 心臓病学
- エンドクリノロジー エンドクリノロジー
- クリニック・リサーチ 臨床研究
背景:
- プロフェッショナル・ソサイエティは,入院患者に対して,ターゲット指向のグルコースコントロールを推奨しています.
- 血糖値上昇と心不全における有害な結果との関連は十分に確立されていません.
研究 の 目的:
- 心不全で入院した患者の入院時の血糖値と死亡率の関連性を調査する.
主な方法:
- 米国 (1998-2001) で心不全で入院した50,532人の高齢患者の全国的に代表的なコホートの分析.
- 多変量コックス回帰モデルは,入院時のグルコースと30日および1年間の全原因死亡率との関連を分析するために使用されました.
- コーホート全体で実施され,糖尿病の状態によって層分化された分析.
主要な成果:
- 多変量調整後の入院時の血糖値と30日間の死亡率との間に有意な関連性は見つかりませんでした.
- 1年後の死亡率の結果は同様のもので,有意な関連性は認められなかった.
- 発見は,既知の糖尿病と未知の糖尿病の患者の間では異なるものではありませんでした.
結論:
- 入院時のグルコースレベルは,入院した心不全患者の大きなコホートでは死亡率と有意に関連していなかった.
- ハイパーグリセミアと急性心筋梗塞における有害なアウトカムとの関係は,心不全などの他の心血管疾患には適用されない場合があります.
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