冠心病介入治疗后血糖水平对临床疗效及预后的影响

祝恒山; 方汉军; 漆 秦; 席 晓

冠心病介入治疗后血糖水平对临床疗效及预后的影响

Effect of blood sugar levels on clinical treatment and prognosis in coronary heart disease patients with diabetes

摘要

摘要: 目的观察冠心病介入治疗后患者血糖水平对临床疗效以及预后的影响。方法将来咸阳医院就诊的120例冠心病介入治疗患者，按患者血糖水平，将其分为3组：非糖尿病组〔空腹血糖（FPG）<7.0 mmol/L，n=30〕、糖尿病低血糖组（8.0 mmol/L>FPG≥7.0 mmol/L,n=50）和糖尿病高血糖组（FPG≥8.0 mmol/L，n=40）。记录临床资料以及分析生化指标〔血清总胆固醇(TC)、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白水平、三酰甘油（TG）、纤维蛋白原（Fib）以及尿酸（UA）水平〕,并分析急性心肌梗死并发症的发生率。结果糖尿病高血糖组TC、LDL-C、载脂蛋白、左室舒张末内径水平分别为（4.9±1.4）mmol/L、（3.3±0.9）mmol/L、（1.6±0.5）mmol/L和（55±7）mm，显著高于糖尿病低血糖组的（4.1±0.8）mmol/L、（2.7±0.5）mmol/L、（1.1±0.4）mmol/L、（51±8）mm (均P<0.05)，糖尿病低血糖组相应指标水平显著高于非糖尿病组的（3.7±1.2）mmol/L、（2.2±0.6）mmol/L、（0.7±0.1）mmol/L和（44±7）mm(均P<0.05)。3组TG、Fib以及UA水平无统计学差异。非糖尿病组患者术后发生急性心肌梗死（AMI）、AMI并发恶性心律失常、AMI并发心衰以及病死率分别为：13%、10%、10%和3%；糖尿病低血糖组为：24%、26%、24%和8%。糖尿病高血糖组为30%、32%、30%和12%。与非糖尿病组比较，糖尿病低血糖组和糖尿病高血糖组相应指标水平均显著升高(均P<0.05)，且糖尿病高血糖组指标水平较糖尿病低血糖组高(均P<0.05)。经过非条件Logistic回归分析后，血糖的OR值（95%CI）为4.6(0.8~21.7)，P<0.05，结果显示血糖水平是独立的预测因素。结论冠心病患者的血糖水平对于患者的临床疗效和预后有一定影响。

Abstract: AIM To examine the effect of blood sugar levels on clinical treatment and prognosis in coronary heart disease (CHD) patients with diabetes. METHODSOne hundred and twenty CHD patients from January 2013 to January 2015 in our hospital were selected and divided into CHD without diabetes mellitus group (group A, n=30, fasting glucose<7.0 tendency/L), CHD with diabetes and low blood sugar group (group B, n=50, 8.0 mmol/L>fasting glucose≥7.0 mmol/L), and CHD with diabetes and hyperglycemia group (group C, n=40, fasting glucose 8.0 mmol/L). Blood pressures and biochemical indicators, including serum total cholesterol, low density lipoprotein, apolipoprotein, fibrinogen, triglyceride, uric acid, and the incidence of the complications of acute myocardial infarction were measured and analyzed. RESULTSAverage systolic blood pressure in group A and group B was (138.9±20.3) mmHg and (139.2±21.0) mmHg, and diastolic blood pressure was (82.6±10.5) mmHg and (83.1±11.3) mmHg, with no significant difference (P>0.05). Serum total cholesterol, low density lipoprotein, apolipoprotein levels and left ventricular end-diastolic diameter in group C were significantly higher than those in group B, and these parameters in group B were significantly than those in group A (P<0.05). No statistical difference was observed in triglycerides, fibrinogen and uric acid levels among the three groups. Postoperative acute myocardial infarction, acute myocardial infarction with malignant arrhythmia, incidence of acute myocardial infarction with heart failure and death rate in group A were lower than those in group B and group C (P<0.05), and these rates in group C were higher than those in group B (P<0.05). CONCLUSIONBlood glucose levels in diabetic patients have some influence on biochemical indicators and complications. Good control of blood sugar level has a positive effect on the treatment and prognosis in CHD patients with diabetes mellitus.

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