论文部分内容阅读
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(P<0.05);频发室性期前收缩和室速发生率显著增加(P<0.05),室颤发生率无显著差异(P>0.05);血糖水平与复极时程呈中度相关(P<0.05);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,P<0.01)。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。
Objective To observe the relationship between blood glucose levels and heart repolarization activity in non-diabetic patients with acute myocardial infarction (AMI) and to explore its impact on prognosis. Methods According to the level of fasting plasma glucose (FPG) in acute stage (1-3 days), 186 patients with AMI without diabetes were divided into control group (5.6-7.8 mmol / L) and high glucose group (> 7.8 mmol / L) . The differences of QT interval, QTc after correction, Tp Te between T wave and end point, Tp Te / QT between QT interval and ventricular arrhythmia were compared between the two groups , The correlation analysis was used to observe the relationship between blood glucose and cardiac repolarization and follow-up. The differences of end point events (recurrent myocardial infarction, hospital admission and death due to heart failure) between the two groups were compared. Cox regression analysis was used to observe the relationship between blood glucose and prognosis . Results Compared with the control group, the 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〕 (P <0.05). The incidence of premature ventricular contraction and ventricular tachycardia increased significantly (P <0.05) and the incidence of ventricular fibrillation had no significant difference (P <0.05). The mean follow-up was (12.4 ± 3.6) months. Survival analysis showed that the incidence of end-point events in high glucose group was higher than that in control group (34.3% vs 20.2 %, P = 0.02). Hyperglycemia was an independent prognostic risk factor (OR 3.75, 95% CI: 2.87-5.25, P <0.01). Conclusion Hyperglycemia seriously affects the ECG activity and prognosis of non-diabetic patients with AMI. Hypoglycemic treatment is expected to improve the clinical outcome of patients.