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目的探讨老年急性心肌梗死患者的应激激素和血糖水平变化及其对预后的影响。方法测定106例非糖尿病老年(≥60岁)急性心肌梗死患者的入院即刻血糖水平,以随机血糖≥7.8mmol/L为应激性高血糖,分为非应激性高血糖组(63例)和应激性高血糖组(43例),对比分析两组的临床资料和皮质醇、生长激素、胰岛素、胰高血糖素、促肾上腺皮质激素(ACTH)水平,及发病30d内心力衰竭、再发心肌梗死、梗死后心绞痛、严重心律失常及因心血管疾病死亡情况。结果应激性高血糖的发生率为40.6%。应激性高血糖组的随机血糖、皮质醇、生长激素、胰高血糖素、ACTH水平均显著高于非应激性高血糖组(P值均<0.01),胰岛素水平显著低于非应激性高血糖组(P<0.01)。应激性高血糖组的心力衰竭、再发心肌梗死、梗死后心绞痛、严重心律失常及因心血管疾病死亡的构成比均显著高于非应激性高血糖组(P值均<0.05)。应激性高血糖组的左心室射血分数(LVEF)为0.4884±0.0737,显著低于非应激性高血糖组的0.5405±0.0624(P<0.05)。结论入院血糖和应激激素异常增高与老年急性心肌梗死患者发病30d内的预后较差相关。
Objective To investigate the changes of stress hormones and blood glucose levels in elderly patients with acute myocardial infarction and their effects on prognosis. Methods The blood glucose level of 106 patients with acute myocardial infarction (≥60years old) admitted to hospital were measured. Random blood glucose≥7.8mmol / L was taken as stress hyperglycemia and divided into non-stress hyperglycemia group (63 cases) And stress hyperglycemia group (43 cases). The clinical data and levels of cortisol, growth hormone, insulin, glucagon, adrenocorticotropic hormone (ACTH) and heart failure within 30 days after onset were compared between the two groups Myocardial infarction, angina after infarction, severe arrhythmia and death due to cardiovascular disease. Results The incidence of stress hyperglycemia was 40.6%. The levels of random blood glucose, cortisol, growth hormone, glucagon and ACTH in stress hyperglycemia group were significantly higher than those in non-stress hyperglycemia group (P <0.01), insulin level was significantly lower than non-stress Hyperglycemia group (P <0.01). The incidence of heart failure, recurrent myocardial infarction, post-infarction angina pectoris, severe arrhythmia and death due to cardiovascular disease in stress hyperglycemia group were significantly higher than those in non-stress hyperglycemia group (all P <0.05). The left ventricular ejection fraction (LVEF) in stress hyperglycemia group was 0.4884 ± 0.0737, which was significantly lower than that in non-stressed hyperglycemia group (0.5405 ± 0.0624, P <0.05). Conclusions The abnormal increase of blood glucose and stress hormone in admission is related to the poor prognosis within 30 days of onset of acute myocardial infarction in the elderly.