Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study
Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study
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DOI：
10.1016/s0140-6736(02)09089-x
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发表时间：
2002-06-22
期刊：
影响因子：
168.9
通讯作者：
Malmberg, K
中科院分区：
文献类型：
--
作者：
Norhammar, A;Tenerz, Å;Malmberg, K
背景：入院时糖代谢状态是急性心肌梗死患者长期死亡率的重要危险指标，无论患者是否已知糖尿病。我们的目的是确定在没有诊断为糖尿病但有心肌梗死的患者中糖代谢受损的患病率，并评估这种异常是否可以在心肌梗死的早期过程中被识别出来。方法：我们进行了一项前瞻性研究，纳入了瑞典两家医院冠状动脉监护室连续收治的181例急性心肌梗死患者，未诊断为糖尿病，血糖浓度低于11.1 mmol/L。我们记录了住院期间的葡萄糖浓度，并在出院时和3个月后分别用75 g葡萄糖进行了标准化的口服葡萄糖耐量试验。结果本组患者的平均年龄为63.5岁（SD 9），入院时平均血糖浓度为6.5 mmol/L（1.4）。出院时平均2小时血糖浓度为9.2 mmol/L(2.9)， 3个月后平均血糖浓度为9.0 mmol/L（3.0）。164人中58人（35%,95% CI 28-43）和144人中58人（40%,32-48）在出院时和3个月后分别出现糖耐量受损，164人中51人（31%,24-38）和144人中36人（25%,18-32）先前未确诊为糖尿病。3个月时糖耐量异常的独立预测因子是入院时的HbA（1c）浓度（p=0.024）和第4天的空腹血糖浓度（p=0.044）。先前未确诊的糖尿病和糖耐量受损在急性心肌梗死患者中很常见。这些异常可在梗死后早期发现。我们的研究结果表明，急性心肌梗死早期的空腹和挑战后高血糖可以作为高危人群的早期标志物。
Background Glycometabolic state at hospital admission is an important risk marker for long-term mortality in patients with acute myocardial infarction, whether or not they have known diabetes mellitus. Our aim was to ascertain the prevalence of impaired glucose metabolism in patients without diagnosed diabetes but with myocardial infarction, and to assess whether such abnormalities can be identified in the early course of a myocardial infarction.Methods We did a prospective study, in which we enrolled 181 consecutive patients admitted to the coronary care units of two hospitals in Sweden with acute myocardial infarction, no diagnosis of diabetes, and a blood glucose concentration of less than 11.1 mmol/L. We recorded glucose concentrations during the hospital stay, and did standardised oral glucose tolerance tests with 75 g of glucose at discharge and again 3 months later.Findings The mean age of our cohort was 63.5 years (SD 9) and the mean blood glucose concentration at admission was 6.5 mmol/L (1.4). The mean 2-h postload blood glucose concentration was 9.2 mmol/L (2.9) at hospital discharge, and 9.0 mmol/L (3.0) 3 months later. 58 of 164 (35%, 95% CI 28-43) and 58 of 144 (40%, 32-48) individuals had impaired glucose tolerance at discharge and after 3 months, respectively, and 51 of 164 (31%, 24-38) and 36 of 144 (25%, 18-32) had previously undiagnosed diabetes mellitus. Independent predictors of abnormal glucose tolerance at 3 months were concentrations of HbA(1c) at admission (p=0.024) and fasting blood glucose concentrations on day 4 (p=0.044).Interpretation Previously undiagnosed diabetes and impaired glucose tolerance are common in patients with an acute myocardial infarction. These abnormalities can be detected early in the postinfarction period. Our results suggest that fasting and postchallenge hyperglycaemia in the early phase of an acute myocardial infarction could be used as early markers of high-risk individuals.