Abnormal glucose regulation in patients with acute ST- elevation myocardial infarction-a cohort study on 224 patients.
Abnormal glucose regulation in patients with acute ST- elevation myocardial infarction-a cohort study on 224 patients.
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DOI：
10.1186/1475-2840-8-6
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发表时间：
2009-01-30
影响因子：
9.3
通讯作者：
Andersen GO
中科院分区：
文献类型：
--
作者：
Knudsen EC;Seljeflot I;Abdelnoor M;Eritsland J;Mangschau A;Arnesen H;Andersen GO
在既往无糖尿病诊断的冠心病患者中，葡萄糖耐量受损和未知2型糖尿病的患病率较高。本研究的目的是调查无已知糖代谢紊乱的急性ST段抬高型心肌梗死（STEMI）患者3个月后血糖调节异常（AGR）的患病率，评估急性STEMI后早期进行的75 g口服葡萄糖耐量试验（OGTT）预测3个月时AGR存在的可靠性，并研究3个月时在医院测量的AGR的其他潜在预测因素。这是一项前瞻性观察性队列研究，入组了224例接受直接PCI治疗的STEMI患者。在急性STEMI后非常早期进行OGTT，并在3个月后在200例患者中重复。我们总结了观察到的确切一致性，并评估了在医院和随访时进行的OGTT的重现性。根据世界卫生组织标准将患者分为糖代谢类别。AGR定义为空腹血糖受损、糖耐量受损和2型糖尿病的总和。3个月时AGR的患病率为24.9%（95% CI 19.1，31.4%），低于住院时的46.9%（95% CI 40.2，53.6）。只有108/201（54%）的患者在重复OGTT后仍处于相同的糖代谢类别。高水平的HbA 1c和入院时的血糖显著预测3个月时的AGR（分别为p < 0.001，p = 0.040），当排除大面积心肌梗死患者时，空腹血糖具有预测作用（p < 0.001）。STEMI患者中AGR的患病率低于预期。HbA 1c、入院时血糖和空腹血糖在医院内测量似乎是有用的长期糖代谢紊乱的早期标志物。STEMI后早期进行OGTT不能提供长期糖代谢状态的可靠信息，可能不推荐。
A high prevalence of impaired glucose tolerance and unknown type 2-diabetes in patients with coronary heart disease and no previous diagnosis of diabetes have been reported. The aims of the present study were to investigate the prevalence of abnormal glucose regulation (AGR) 3 months after an acute ST-elevation myocardial infarction (STEMI) in patients without known glucometabolic disturbance, to evaluate the reliability of a 75-g oral glucose tolerance test (OGTT) performed very early after an acute STEMI to predict the presence of AGR at 3 months, and to study other potential predictors measured in-hospital for AGR at 3 months. This was an observational cohort study prospectively enrolling 224 STEMI patients treated with primary PCI. An OGTT was performed very early after an acute STEMI and was repeated in 200 patients after 3 months. We summarised the exact agreement observed, and assessed the observed reproducibility of the OGTTs performed in-hospital and at follow up. The patients were classified into glucometabolic categories defined according to the World Health Organisation criteria. AGR was defined as the sum of impaired fasting glucose, impaired glucose tolerance and type 2-diabetes. The prevalence of AGR at three months was 24.9% (95% CI 19.1, 31.4%), reduced from 46.9% (95% CI 40.2, 53.6) when measured in-hospital. Only, 108 of 201 (54%) patients remained in the same glucometabolic category after a repeated OGTT. High levels of HbA1c and admission plasma glucose in-hospital significantly predicted AGR at 3 months (p < 0.001, p = 0.040, respectively), and fasting plasma glucose was predictive when patients with large myocardial infarction were excluded (p < 0.001). The prevalence of AGR in STEMI patients was lower than expected. HbA1c, admission plasma glucose and fasting plasma glucose measured in-hospital seem to be useful as early markers of longstanding glucometabolic disturbance. An OGTT performed very early after a STEMI did not provide reliable information on long-term glucometabolic state and should probably not be recommended.
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DOI：
10.1007/bf01477070
发表时间：
1980-01-01
期刊：
KLINISCHE WOCHENSCHRIFT
影响因子：
--
作者：
KOBBERLING, J;KERLIN, A;CREUTZFELDT, W
通讯作者：
CREUTZFELDT, W
影响因子：
--
作者：
Borch-Johnsen, K;Neil, A;Qiao, Q
通讯作者：
Qiao, Q
影响因子：
37.8
作者：
Gibbons, RJ;Miller, TD;Christian, TF
通讯作者：
Christian, TF
影响因子：
16.2
作者：
Tenerz, Å;Norhammar, A;Malmberg, K
通讯作者：
Malmberg, K
影响因子：
11.1
作者：
Bartnik, M.;Norhammar, A.;Ryden, L.
通讯作者：
Ryden, L.