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与急性心肌梗塞的低血糖和高血糖相关的不同临床结果
Abhinav Goyal1, Shamir R Mehta, Rafael Díaz
1MHS, 1518 Clifton Rd NE, Room 456, Atlanta, GA 30322, USA. agoyal4@emory.edu
Circulation
|December 2, 2009
概括
急性心肌梗塞 (AMI) 患者的高血糖预测死亡. 入院时的低血糖显示出非显著的趋势,入院后的低血糖与死亡率无关,这表明它可能不会直接导致不良后果.
科学领域:
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
- 临界护理医学 临界护理医学
背景情况:
- 过高血糖是急性心肌梗塞 (AMI) 患者死亡的一个已知的预测因素.
- 低血糖在AMI的预后意义仍然存在争议,需要进一步调查.
研究的目的:
- 在一大群AMI患者中评估低血糖和高血糖的预后意义.
- 为了比较30天死亡率的入院和入院后葡萄糖水平的预测值.
主要方法:
- 从两项大型葡萄糖-胰岛素-治疗试验中对30536名AMI患者进行了临时分析.
- 多变量考克斯模型用于评估低血糖 (<或=70毫克/分升) 和高血糖 (>或=140毫克/分升) 与正常血糖的预后值.
- 用替代低血糖定义和分组 (糖尿病,胰岛素治疗) 重复分析.
主要成果:
- 住院和住院后的高血糖 (>=140 mg/dL) 均显著预测了30天死亡率的增加 (aHR分别为1.43和1.47).
- 接受治疗时的低血糖 (<=70 mg/dL) 并没有预后 (aHR 1.16),接受治疗后的低血糖 (aHR 0.96) 也没有.
- 这些发现在不同的低血糖定义和糖尿病患者中保持一致.
结论:
- 住院和住院后的高血糖是AMI患者30天死亡率的显著预测因素.
- 低血糖,特别是在入院后,似乎不是AMI中不良结果的直接调解者.
- 临床重点应继续放在AMI患者的高血糖管理上.
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