摘要
目的:探讨糖尿病是否为影响急性心肌梗死(AMI)患者住院病死率的独立危险因素。方法:回顾分析2136例AMI患者,根据是否并发糖尿病分为2组,比较2组患者的临床特征、住院治疗和并发症发生率,并对可能影响AMI患者住院病死率的因素进行多因素回归分析。结果:与非糖尿病组相比,糖尿病组患者年龄较大[(65.5±10.3)比(62.4±11.8)岁,P<0.01],空腹血糖较高[(10.4±3.2)比(5.6±1.2)mmol/L,P<0.01],女性较多(46.4%比24.8%,P<0.01),多伴有高血压(49.9%比42.8%,P<0.01)和血脂异常(63.9%比58.7%,P<0.05),心功能≥KillipⅢ级者较多(11.3%比5.8%,P<0.01),急性期再灌注治疗率(22.3%比30.6%,P<0.01)和住院期间β受体阻滞剂的使用率(64.5%比70.6%,P<0.05)较低。糖尿病组患者住院病死率显著高于非糖尿病组(14.4%比5.9%,P<0.01)。多因素回归分析显示,年龄、高血压、糖尿病、空腹血糖、血脂异常、心功能Killip分级、再灌注治疗和β受体阻滞剂的使用率均为影响AMI患者住院病死率的独立危险因素。结论:糖尿病是影响AMI患者住院病死率的独立危险因素。
Objective：To investigate whether diabetes mellitus is an independent predictor of in hospital death in patients with acute myocardial infarction （AMI）. Method： A retrospective study was carried out in 2 136 patients with AMI including 485 diabetics and 1 651 nondiahetics. Baseline characteristics, therapeutic approaches and the occurrence rate of angina pectoris, reinfarction, heart failure and death during hospitalization were compared be tween diabetic and nondiabetic patients. To identify risk factors that are predictive of in-hospital death, multivari ate logistic regression analysis was used. Result： Patients with diabetes mellitus were substantially older（E65.5 ±10.3] vs [62.4±11.8]years, P〈0.01） and exhibited a high level of fasting glucose （[10.4±3.21 vs [5.6±1.21 mmol/L, P〈0.01） than those without. Females（46.4% vs 24.8% ,P〈0.01）, patients with Killip class greater than or equal to Ⅲ （11.3% vs 5.8%, P〈0.01 ）were more common in diabetic than in nondiabetic patients. The prevalence of hypertension and hyperlipidemia in diabetic patients was higher than that in nondiabetic patients （49.9% vs 42.8 %, P〈0.01; 63.9% vs 58.7%, P〈0.05, respectively）. Diabetic patients received reperfusion therapy including both thrombosis and primary PCI less frequently than nondiabetic patients within the first 12 hours after symptom onset （22.3% vs 30.6%,P〈0.01）. Furthermore, beta receptor blockers were underused in diabetic patients during hospitalization （64.5% vs 70. 5%, P〈0.05）. An increased mortality was demonstrated in diabetic patients during the hospitalization phase of AMI（14.4% vs 5.9%, P〈0.01）. The results of logistic regression demonstrated that age, hypertension, diabetes mellitus, fasting glucose,hyperlipidemia, Killip class of cardiac function, and administration of reperfusion therapy and beta receptor blockers were independent predictors of in-hospital death in patients with AMI. Conclusion： Diabetes mellitus is an independent predietor of in hospital death in hospitalized patients with AMI.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2008年第12期916-918,共3页
Journal of Clinical Cardiology
基金
山东省科学技术发展重点项目(No:2002BB1CJA1)
关键词
心肌梗死
糖尿病
死亡率
Myocardial infarction
Diabetes mellitus
Mortality
作者简介
通讯作者：蒋世亮，E—mail：jsl—telephone@163．com
