STEMI患者入院血糖水平对急诊经皮冠状动脉介入治疗后TIMI帧数的影响
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摘要
目的:探讨行急诊PCI(pPCI)的ST段抬高型心肌梗死(STEMI)患者入院血糖水平与冠脉血运重建血流TIMI帧数(TFC)之间的关系。方法:选取2015年1月-2017年6月本院收治的行pPCI的STEMI患者188例,根据入院血糖水平将其分为高血糖组(n=65)和非高血糖组(n=123)。比较两组一般资料及冠心病危险因素;分析冠脉血管病变特征及介入治疗情况、TFC与入院血糖水平的相关关系,明确影响TFC的危险因素。结果:高血糖组中年龄、糖尿病患者比例均高于非高血糖组(P<0.05);高血糖组GRACE评分、术中无复流比例、术后TFC均高于非高血糖组,差异均有统计学意义(P<0.05);Person相关分析显示,无论是否既往有糖尿病病史,TFC与入院血糖水平均呈正相关(P<0.05);多元回归分析显示,入院血糖水平是TFC的独立预测因子(P<0.05)。结论:入院血糖水平是STEMI患者的犯罪血管PCI术后高TFC独立预测因子。
Objective:To investigate the relationship between blood glucose level and TIMI frame count(TFC)of coronary revascularization in patients with ST-segment elevation myocardial infarction(STEMI)undergoing emergency PCI(pPCI).Method:A total of 188 STEMI patients for pPCI from January 2015 to June 2017 in our hospital were selected,according to admitted blood glucose levels,they were divided into hyperglycemic groups(n=65)and non-hyperglycemic groups(n=123).The general data and coronary heart disease risk factors of two groups were compared,the characteristics of coronary vascular lesions and interventional therapy,and the correlation between TFC and admitted blood glucose levels were analyzed,and the risk factors affecting TFC were analyzed.Result:The proportion of age and diabetes mellitus in hyperglycemia group were higher than those of non-hyperglycemia group(P<0.05).The GRACE score,intraoperative no-reflow ratio and postoperative TFC in hyperglycemia group were higher than those of non-hyperglycemia group(P<0.05).Person analysis shows that whether or not there is a history of diabetes,TFC was positively correlated with admitted blood glucose level(P<0.05).Multivariate regression analysis showed that admission blood glucose level was an independent predictor of TFC(P<0.05).Conclusion:Admission blood glucose is an independent predictor of high TFC in STEMI patients after PCI.
Objective:To investigate the relationship between blood glucose level and TIMI frame count(TFC)of coronary revascularization in patients with ST-segment elevation myocardial infarction(STEMI)undergoing emergency PCI(pPCI).Method:A total of 188 STEMI patients for pPCI from January 2015 to June 2017 in our hospital were selected,according to admitted blood glucose levels,they were divided into hyperglycemic groups(n=65)and non-hyperglycemic groups(n=123).The general data and coronary heart disease risk factors of two groups were compared,the characteristics of coronary vascular lesions and interventional therapy,and the correlation between TFC and admitted blood glucose levels were analyzed,and the risk factors affecting TFC were analyzed.Result:The proportion of age and diabetes mellitus in hyperglycemia group were higher than those of non-hyperglycemia group(P<0.05).The GRACE score,intraoperative no-reflow ratio and postoperative TFC in hyperglycemia group were higher than those of non-hyperglycemia group(P<0.05).Person analysis shows that whether or not there is a history of diabetes,TFC was positively correlated with admitted blood glucose level(P<0.05).Multivariate regression analysis showed that admission blood glucose level was an independent predictor of TFC(P<0.05).Conclusion:Admission blood glucose is an independent predictor of high TFC in STEMI patients after PCI.
引文
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[12]宣兵.AMI患者PCI术后校正TIMI帧数与梗死区域心肌组织收缩功能的影响[J].检验医学与临床,2018,15(14):2083-2085.
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[16]Marenzi G,De Metrio M,Rubino M,et al.Acute hyperglycemia and contrast-induced nephropathy in primary percutaneous coronary intervention[J].Am Heart J,2010,160(6):1170-1177.
[17]El O J,Ghalem A,El O G,et al.Management of hyperglycemia during and in the immediate follow-up of acute coronary syndrome[J].J Saudi Heart Assoc,2018,30(2):113-121.
[19]Gulel O,Akcay M,Soylu K,et al.Left Ventricular Myocardial Deformation Parameters Are Affected by Coronary Slow Flow Phenomenon:A Study of Speckle Tracking Echocardiography[J].Echocardiography,2016,33(5):714-723.
[20]Wagdy S,Sobhy M,Loutfi M.Neutrophil/Lymphocyte Ratio as a Predictor of In-Hospital Major Adverse Cardiac Events,New-Onset Atrial Fibrillation,and No-Reflow Phenomenon in Patients with ST Elevation Myocardial Infarction[J].Clin Med Insights Cardiol,2016,10(10):19-22.
[21]Nurkalem Z,Hasdemir H,Ergelen M,et al.The relationship between glucose tolerance and severity of coronary artery disease using the Gensini score[J].Angiology,2010,61(8):751-755.
[22]陈冬生,栾献亭.不同血糖水平对急性心肌梗死患者急诊冠状动脉介入术后心肌灌注及预后的影响[J].右江医学,2018,46(3):310-313.
[23]Ertelt K,Brener S J,Mehran R,et al.Comparison of Outcomes and Prognosis of Patients With Versus Without Newly Diagnosed Diabetes Mellitus After Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction(the HORIZONS-AMI Study)[J].Am J Cardiol,2017,119(12):1917-1923.
[4]丁林,吕肖锋,武晋晓,等.2型糖尿病合并冠心病患者血糖波动与冠状动脉病变的相关性研究[J].重庆医学,2015,44(17):2344-2346.
[5]邹云增,杨茗.Ⅱ型糖尿病合并冠心病的机制[J].临床心血管病杂志,2015,31(4):366-369.
[6]Sudhir K,Hermiller J B,Ferguson J M,et al.Risk factors for coronary drug-eluting stent thrombosis:influence of procedural,patient,lesion,and stent related factors and dual antiplatelet therapy[J].ISRN Cardiol,2013,2013:748736.
[7]Meloni L,Montisci R,Sau L,et al.Admission hyperglycemia in acute myocardial infarction:possible role in unveiling patients with previously undiagnosed diabetes mellitus[J].J Cardiovasc Med(Hagerstown),2013,14(11):821-826.
[8]Kaul S.The"no reflow"phenomenon following acute myocardial infarction:mechanisms and treatment options[J].J Cardiol,2014,64(2):77-85.
[9]徐冰,李益民,何胜虎,等.校正TIMI计帧法与微循环阻力指数诊断冠状动脉微循环障碍的对比研究[J].中国实用内科杂志,2016,36(6):489-492.
[10]江慧琳,李云妹,莫均荣,等.TIMI评分对急诊急性心肌梗死患者30天预后的预测价值[J].岭南急诊医学杂志,2015,20(3):180-183.
[11]王燕芳,刘志宏,韩雅君.冠脉慢血流对Pd、QTd及ST段改变的影响[J].内蒙古医科大学学报,2018,40(3):262-267.
[12]宣兵.AMI患者PCI术后校正TIMI帧数与梗死区域心肌组织收缩功能的影响[J].检验医学与临床,2018,15(14):2083-2085.
[13]Karamat M A,Raja U Y,Manley S E,et al.Prevalence of undiagnosed type 2 diabetes in patients admitted with acute coronary syndrome:the utility of easily reproducible screening methods[J].BMC Endocr Disord,2017,17(1):3-6.
[14]叶永刚,蒋利,王寅,等.C反应蛋白和空腹血糖与急性冠脉综合征患者近期预后的相关性研究[J].实用临床医药杂志,2013,17(9):19-22.
[15]Schernthaner G,Schernthaner-Reiter M H,Schernthaner GH.EMPA-REG and Other Cardiovascular Outcome Trials of Glucose-lowering Agents:Implications for Future Treatment Strategies in Type 2 Diabetes Mellitus[J].Clin Ther,2016,38(6):1288-1298.
[16]Marenzi G,De Metrio M,Rubino M,et al.Acute hyperglycemia and contrast-induced nephropathy in primary percutaneous coronary intervention[J].Am Heart J,2010,160(6):1170-1177.
[17]El O J,Ghalem A,El O G,et al.Management of hyperglycemia during and in the immediate follow-up of acute coronary syndrome[J].J Saudi Heart Assoc,2018,30(2):113-121.
[19]Gulel O,Akcay M,Soylu K,et al.Left Ventricular Myocardial Deformation Parameters Are Affected by Coronary Slow Flow Phenomenon:A Study of Speckle Tracking Echocardiography[J].Echocardiography,2016,33(5):714-723.
[20]Wagdy S,Sobhy M,Loutfi M.Neutrophil/Lymphocyte Ratio as a Predictor of In-Hospital Major Adverse Cardiac Events,New-Onset Atrial Fibrillation,and No-Reflow Phenomenon in Patients with ST Elevation Myocardial Infarction[J].Clin Med Insights Cardiol,2016,10(10):19-22.
[21]Nurkalem Z,Hasdemir H,Ergelen M,et al.The relationship between glucose tolerance and severity of coronary artery disease using the Gensini score[J].Angiology,2010,61(8):751-755.
[22]陈冬生,栾献亭.不同血糖水平对急性心肌梗死患者急诊冠状动脉介入术后心肌灌注及预后的影响[J].右江医学,2018,46(3):310-313.
[23]Ertelt K,Brener S J,Mehran R,et al.Comparison of Outcomes and Prognosis of Patients With Versus Without Newly Diagnosed Diabetes Mellitus After Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction(the HORIZONS-AMI Study)[J].Am J Cardiol,2017,119(12):1917-1923.