急性冠脉综合征患者入院时糖化血红蛋白水平对住院死亡的影响

汤勇

doi:10.13201/j.issn.1001-1439.2015.05.020

急性冠脉综合征患者入院时糖化血红蛋白水平对住院死亡的影响

汤勇

- 自贡市第四人民医院心内科(四川自贡, 643000)

详细信息

作者简介:
汤勇,E-mail:717531270@qq.com

中图分类号: R541.4

收稿日期: 2014-06-29

Impact of admission hemoglobin A1c on the in-hospital mortality in patients with acute coronary syndrome

TANG Yong

- Department of Cardiology, Zigong Fourth People's Hospital, Zigong, 643000, China

Received Date: 29 June 2014

摘要

摘要: 目的:研究急性冠脉综合征(ACS)患者入院时糖化血红蛋白(HbA1c)和住院死亡之间的相关性。方法:回顾性分析2008-01-2013-12于我院心内科住院的517例ACS患者的临床资料。按入院时HbA1c值将患者分为3组:≤5.6%组(286例)、5.7%~6.4%组(114例)和≥6.5%组(117例)。比较各组患者基线资料、住院期间治疗及住院死亡率的差异。对影响ACS患者住院死亡率的因素进行Cox回归分析。结果:517例患者中,急性ST抬高心肌梗死患者330例(63.8%),急性非ST段抬高心肌梗死患者100例(19.3%),不稳定型心绞痛患者87例(16.8%)。与入院时HbA1c正常的患者相比,HbA1c升高的患者平均年龄较大、伴心力衰竭和卒中病史及Killip分级>Ⅰ级的比例较高(P均<0.05)。入院时肌钙蛋白水平较高、左室射血分数(LVEF)较HbA1c正常患者低(P均<0.05)。但入院后接受经皮冠脉介入(PCI)治疗的比例较低(P<0.05)。住院期间3组死亡率分别是5.6%、7.9%和14.5%(P<0.05)。Cox回归分析显示,调整了性别、年龄、既往病史、入院时生命体征、ACS类型和住院期间主要治疗措施后,入院时HbA1c≥6.5%仍是影响住院死亡的独立危险因素(HR=2.247,95%CI 1.462~4.287,P=0.012),但入院时HbA1c5.7%~6.4%未显著增加住院死亡风险(HR=1.105,95%CI0.832~1.436,P=0.125)。结论:ACS患者入院时HbA1c水平和住院死亡有关,入院时HbA1c≥6.5%显著增加住院死亡风险,而HbA1c5.7%~6.4%对住院死亡无显著影响。
- 急性冠脉综合征 /
- 糖化血红蛋白 /
- 住院死亡
Abstract: Objective:To investigate the impact of admission Hemoglobin A1c(HbA1c) on the in-hospital allcause mortality in patients with acute coronary syndrome(ACS).Method:Data of 517 patients hospitalized ACS from Jan 2010 to Dec 2013 were retrospectively analyzed.Patients were divided into 3groups according to the admission HbA1clevel: ≤ 5.6%(n=286),5.7%~6.4%(n=114),and ≥ 6.5%(n=117).Baseline characteristics,treatment during hospitalization,and in-hospital all-cause mortality were compared among groups.Cox analysis was used to filter the factors associated with the in-hospital all-cause mortality.Result:In all 517 patients with ACS,330 were ST segment elevation myocardial infarction(63.8%),100 were non-ST segment elevation myocardial infarction(19.3%),and 87 were unstable angina(16.8%).Compared with those with normal admission HbA1 c,patients with elevated admission HbA1 cwere more likely to be older,coexist heart failure and a history of stroke,and tended to present with Killip>Ⅰ class on admission(P<0.05).Moreover,higher admission TnI level and lower left ventricular ejection fraction(LVEF) were found in patients with elevated admission HbA1c(all P<0.05).However,the percentage of patients with elevated admission HbA1 cthat received percutaneous coronary intervention(PCI) was lower than that of patients with normal admission HbA1c(P<0.05).The in-hospital all-cause mortality in patients with admission HbA1 ≤ 5.6%,5.7%~6.4%,and ≥ 6.5% were 5.6%,7.9%,and 14.5%,respectively(P<0.05).After adjusting for gender,age,medical histories,admission vital signs,type of ACS,and treatment during hospitalization,admission HbA1c ≥ 6.5% was still an independent risk factor for in-hospital mortality(HR=2.247,95%CI 1.462~4.287,P=0.012),whereas admission HbA1c5.7%~6.4%was not associated with increased risk of in-hospital mortality(HR=1.105,95%CI 0.832~1.436,P=0.125).Conclusion:Admission HbA1 clevel was associated with in-hospital mortality in patients with ACS and admission HbA1c ≥ 6.5% predicted increased risk of in-hospital mortality while HbA1c5.7%~6.4% had no significant effect on the in-hospital mortality.
- acute coronary syndrome(ACS) /
- hemoglobin A1c /
- in-hospital mortality

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