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目的探讨应激性高血糖(SHG)与急性心肌梗死(AMI)患者直接经皮冠状动脉腔内介入治疗(PCI)时心肌缺血再灌注损伤(MIRI)发生的关系及对患者近期预后的影响。方法选择2007年6月至2008年10月广州市第一人民医院心内科院心内科接受直接PCI治疗的急性ST段抬高型AMI患者156例,均为非糖尿病患者。按AMI起病后24h内空腹血糖(FBS)浓度分为对照组(FBS<6.1mmol/L)与SHG组(FBS≥6.1mmol/L),SHG组患者又分为一般应激组(FBS≤11.1mmol/L)和严重应激组(FBS>11.1mmol/L)。比较3组患者直接PCI术中MIRI的发生率,肌酸激酶同工酶(CK-MB)峰值、峰值时间,术后心肌灌注水平指标校正TIMI帧计数(CTFC)、术后2hST段回落(STR)及术后30d内主要不良心脏事件(MACE)的发生率。结果对照组患者与SHG组患者在一般临床基线情况及冠状动脉造影资料方面差异无统计学意义(P>0.05),但在MIRI发生率、CK-MB峰值、峰值时间及CTFC、STR等指标方面对照组均优于SHG组,一般应激组又优于严重应激组,差异有统计学意义(P均<0.05),直接PCI术后30d内MACE的发生率SHG组显著高于对照组(19.39%与6.90%,P<0.05)。多因素Logistic回归分析显示SHG是直接PCI术中MIRI发生的独立预测因子(P<0.05)。结论SHG与AMI患者直接PCI治疗时MIRI的发生及严重程度存在相关性,SHG加剧MIRI可能是影响AMI患者直接PCI术后近期预后的重要因素。
Objective To investigate the relationship between the occurrence of myocardial ischemia-reperfusion injury (MIRI) and the short-term prognosis of patients with stress hyperglycemia (SHG) and acute myocardial infarction (AMI) undergoing direct percutaneous coronary intervention . Methods From June 2007 to October 2008, 156 patients with acute ST-segment elevation AMI undergoing direct PCI in Cardiology Department of First People’s Hospital of Guangzhou City were all non-diabetic patients. The fasting plasma glucose (FBS) concentrations were divided into control group (FBS <6.1mmol / L) and SHG group (FBS≥6.1mmol / L) within 24 hours after AMI onset. Patients in SHG group were further divided into general stress group 11.1 mmol / L) and severe stress group (FBS> 11.1 mmol / L). The incidences of MIRI, peak CK-MB, peak time and postoperative myocardial perfusion were compared between the three groups in terms of TIMI frame count (CTFC) ) And the incidence of major adverse cardiac events (MACE) within 30 days after surgery. Results There was no significant difference between the control group and the SHG group in the general clinical baseline and coronary angiography (P> 0.05). However, there were no significant differences in the incidence of MIRI, the peak value of CK-MB, peak time, CTFC and STR The control group were superior to the SHG group, the general stress group was superior to the severe stress group, the difference was statistically significant (all P <0.05), the incidence of MACE within 30 days after PCI was significantly higher than that of the control group 19.39% and 6.90%, P <0.05). Multivariate Logistic regression analysis showed that SHG was an independent predictor of MIRI in direct PCI (P <0.05). Conclusions There is a correlation between the occurrence and severity of MIRI in patients with SHG and AMI treated with direct PCI. Intensive MIRI with SHG may be an important factor that affects the short-term prognosis of patients with AMI after PCI.