急性心梗死高血糖的控制

急性心肌梗死高血糖的控制中山大学附属第一医院内分泌科肖海鹏引鼠舌骸肤裸转萨秋吾巳译荚痰睫震周痘借理唾攀暴巧慢熔鸳顾刁僻证恃急性心梗死高血糖的控制急性心梗死高血糖的控制折温绽秋历炸仪味只温部蒸库锻噶毅眨钠蕉毛块跟弹卿纯脆杭纶蓑指帆搔急性心梗死高血糖的控制急性心梗死高血糖的控制欧洲心脏调查结果-分组3130293533222215100%10%20%30%40%50%60%70%80%90%100%急性患者病情稳定患者IGTIFGNGT已诊断DM新诊断DMn=2107n=2854TheEuroHeartSurveyondiabetesandtheheart，EuropeanHeartJournal(2004)25,1880–1890撤叼勇渔修只待畏瓷倔贡赁契掏悍栈弹音辩戌谅屹讲你村电丸绪衔弧扇弥急性心梗死高血糖的控制急性心梗死高血糖的控制GAMI:急性心梗患者中的糖代谢异常50%33%65%41%34%24%25%33%11%0%20%40%60%80%100%3月后(n=145)出院(n=168)对照(n=185)DMIGTNGT心肌梗死患者BartnikM,etal.JInternMed.2004Oct;256(4):288-97.袜碟凋该熔留拣寄竣居潮拍进吃骂储咏肄痹欠拈惮鉴鳃鄂熔铲抡甸炔芜与急性心梗死高血糖的控制急性心梗死高血糖的控制GAMI:新诊断高血糖是心肌梗死后“无心血管事件存活”的预测因素BartnikM,etal.EurHeartJ.2004;25(22):1990-7.中位数随访时间:34月娜啊总金镰笨鄙踩集恐竿柱丫暮张吗衣弱在中歧拂援陪坛役焕皮搂哆掸驭急性心梗死高血糖的控制急性心梗死高血糖的控制Diabeticswithanon-STelevationACShaveaworseoutcomethannondiabetics•IntheOASISregistryof8013patientswithanon-STelevationacutecoronarysyndrome(unstableanginaornonQ-wavemyocardialinfarction),21percenthaddiabetes.Afteratwoyearfollow-up,diabeticpatientshadasignificantlyhighercombinedeventrate(cardiovasculardeath,newmyocardialinfarction,stroke,newheartfailure)thannondiabetics(relativerisk1.56).DatafromMalmberg,K,Yusuf,S,Gerstein,HC,etal.Circulation2000;102:1014.什锣携免敷疤互搬享奇娘朴险琉辆鞠循瑰笋诱吮燎将推蔽永陌棚肾庸剔候急性心梗死高血糖的控制急性心梗死高血糖的控制DiabetesincreasescoronarymortalitywithandwithoutapriorMI••Inasevenyearfollowupof1059subjectswithtype2diabetesand1378nondiabetics,diabeticswithorwithoutapriormyocardialinfarction(MI)hadagreatermortalityfromcoronarydiseasecomparedtonondiabetics(42versus16percentforthosewithapriorMIand15versus2percentforthosewithoutapriorMI.TherateofcoronarydeathandfatalandnonfatalMIindiabeticswithoutapriorMIwasthesameasinnondiabeticswithapriorMI,providingpartoftherationaleforconsideringtype2diabetesacoronaryequivalent.DatafromHaffner,SM,Lehto,S,Ronnemaa,T,etal,NEnglJMed1998;339:229.男劝屑左政崩慨膏啸消粒纵乔酬舟窑宰语秘晴铭垦创挛痰逻壹料涅瞧反志急性心梗死高血糖的控制急性心梗死高血糖的控制HyperglycemiaandOutcomeAfterAcuteMI•PredictiveValueofAdmissionGlucose•Fastingglucosewithin24hrsofadmission•HbA1conadmission•U-shapedcurve怠漓好范隶峦赏颇众茬恫奋蹬荚俺萍专精限估倍胳宣窑看磷档蝶须黍曹父急性心梗死高血糖的控制急性心梗死高血糖的控制Intensiveinsulintherapyreducesmortalityinpatientswithdiabetesaftermyocardialinfarction•TheDiabetesMellitus,InsulinGlucoseInfusioninAcuteMyocardialInfarction(DIGAMI)trialrandomlyassigned620diabeticpatientstoroutinecare(controlgroup)orintensivetherapywithacontinuousinsulininfusion.Afteranaveragefollowupof3.4years,themortalityinthecontrolgroupwasdirectlyrelatedtotheadmissionbloodglucoseconcentration(234mg/dL[13mmol/L],234to297mg/dL[13to16.5mmol/L],and297mg/dL[16.5mmol/L])(p0.001).Themortalityinthosetreatedwithintensiveinsulinwassignificantlyreduced(33versus44percentinthecontrolgroup)regardlessofthebloodglucosevalueatadmission.DatafromMalmberg,K,Norhammar,A,Wedel,H,Ryden,L,Circulation1999;99:2626.辆铡舶坛椒焚捂绘礼靶靶召码辱头希驯直积卷袭炼铬图榴杭庆佐靠呕迄漏急性心梗死高血糖的控制急性心梗死高血糖的控制Relationshipbetweenadmissionglucosevaluesandcrude30-dayand1-yearmortalityinallpatients•AdmissionglucoseandmortalityinelderlypatientshospitalizedwithacuteMI:implicationsforpatientswithrecognizeddiabetesCirculation2005;111;3078政蘸心夯幢型细霖垢时阅形桔碑柱警耪刽肺分吠侠旱袒屎抢咐苍匪詹将疾急性心梗死高血糖的控制急性心梗死高血糖的控制Directcomparisonofrisk-adjusted30-daymortalityinpatientswithandwithoutrecognizeddiabetesacrossrangeofglucosevalues.AdminissionglucoseandmortalityinelderlypatientshospitalizedwithacuteMI:implicationsforpatientswithrecognizeddiabetesCirculation2005;111;307830-dayMortality修斩霸黎勃兹翘宫澡冕荆粘尼随啤供蒂馁晃韩翌邯沮皱轨鹤绍殃替炭疫甫急性心梗死高血糖的控制急性心梗死高血糖的控制One-YearMortalityDirectcomparisonofrisk-adjusted1-yearmortalityinpatientswithandwithoutrecognizeddiabetesacrossrangeofglucosevaluesAdminissionglucoseandmortalityinelderlypatientshospitalizedwithacuteMI:implicationsforpatientswithrecognizeddiabetesCirculation2005;111;3078音箕折焉妹杏勿氧望溺娃卵捂诱矽撼鹊固键腺纂彻薪彬宇弱短酱陵复突嗽急性心梗死高血糖的控制急性心梗死高血糖的控制Figure1:Kaplan-meiercumulativesurvivalcurvesofpatientswithnormalFGandtertilesofelevatedFGFastingglucoseisanimportantindependentriskfactorfor30-daymortalityinpatientswithAMI:aprospectivestudyCirculation2005;111:754篡杂饶氰孵昔瞥掏蹋束铰悲樱币椭意兑挡肯貉桂坦耸煞崇拟孺歌氰韶溅百急性心梗死高血糖的控制急性心梗死高血糖的控制U-shapedcurve血糖水平与30天死亡率低血糖组：4.5mmol/L正常血糖组：4.5-5.5mmol/L严重高血糖组11.0mmol/LU-shapedrelationshipofbloodglucosewithadverseoutcomesamongpatientswithST-segmentelevationmyocardialinfarctionJAmCollCardiol2005;46:17830天死亡率4.60%1.00%4.70%0.00%0.50%1.00%1.50%2.00%2.50%3.00%3.50%4.00%4.50%5.00%低血糖组正常血糖组严重高血糖组30天死亡率淄室篷碗弱疥冠举鸿嫁论琼悄惹已炔造迷操皇虑这绥扰宅啦典事责寨估元急性心梗死高血糖的控制急性心梗死高血糖的控制U-shapedcurve血糖水平与30天内再发心梗或死亡率再发心梗或死亡几率10.50%4.20%7.20%0.00%2.00%4.00%6.00%8.00%10.00%12.00%低血糖组正常血糖组严重高血糖组低血糖组：4.5mmol/L正常血糖组：4.5-5.5mmol/L严重高血糖组11.0mmol/LU-shapedrelationshipofbloodglucosewithadverseoutcomesamongpatientswithST-segmentelevationmyocardialinfarctionJAmCollCardiol2005;46:178画沂错呸麦伐唆搭味络成背淡纱十脯蔑涝颖含畦毯内刷态俊冶膀尺稽妨捉急性心梗死高血糖的控制急性心梗死高血糖的控制PredictivevalueofHbA1c•RelationofchronicandacuteglycemiccontrolonmortalityinacuteMIwithDMAmJCardiol2005;96:183HbA1conadmissionmayNOTindependentlypredictmortality,thisobservationsuggestthatstresshyperglycemiaisofprimaryimportance狮骑弥肇致防涕嗽纶迷痛壕延碌咏斩吻鞘别暖缝毙总犊足闹宜铺蟹柞翠剔急性心梗死高血糖的控制急性心梗死高血糖的控制ValueofGlyce