2023 年第 5 期 第 18 卷

ST段抬高型心肌梗死患者合并糖尿病对心肌挽救和损伤的影响及与预后的相关性

Effect of diabetes mellitus in patients with ST-segment elevation myocardial infarction on myocardial rescue and injury and its correlation with prognosis

作者：洪烈凯谢燕丹郑杰洪

英文作者：Hong Liekai Xie Yandan Zheng Jiehong

单位：汕头大学医学院第一附属医院心内科，汕头515100

英文单位：Department of Cardiology the First Affiliated Hospital of Shantou University Medical College Shantou 515100 China

关键词：ST段抬高型心肌梗死；糖尿病；心肌损伤；葡萄糖目标范围内时间

英文关键词：ST-segmentelevationmyocardialinfarction;Diabetesmellitus;Myocardialinjury;Timeinrange

• 摘要：

• 目的 探讨ST段抬高型心肌梗死(STEMI)患者合并糖尿病对超声心动图联合心肌肌钙蛋白T（cTnT）峰值所确定的心肌挽救和损伤的影响及与预后的相关性。方法 回顾性分析2017年8月至2020年8月汕头大学医学院第一附属医院收治的792例STEMI患者的临床资料，根据是否合并糖尿病将患者分为糖尿病组（160例）和非糖尿病组（632例），糖尿病组患者再根据葡萄糖目标范围内时间（TIR）是否达标分为TIRDM组（TIR≥70%、达标，74例）和NTIRDM组（TIR＜70%、未达标，86例）。比较各组主要不良心脑血管事件(MACCE)发生情况及超声心动图指标和cTnT峰值水平。采用Kaplan-Meier方法 比较各组MACCE发生风险。采用Cox回归方法分析MACCE发生的相关因素。结果  所有患者随访24个月发生MACCE共53例(6.7%)。Kaplan-Meier分析结果显示，糖尿病组MACCE发生风险高于非糖尿病组(Log-rank P=0.02)。NTIRDM组MACCE发生风险高于TIRDM组和非糖尿病组(Log-rank P＜0.01)。多因素Cox回归分析结果显示，NTIRDM（比值比=2.24，95%置信区间：1.09～4.62，P=0.03）与STEMI患者发生MACCE有关。TIRDM组、NTIRDM组、非糖尿病组超声心动图指标及cTnT峰值水平比较差异均无统计学意义(均P＞0.05)。结论   糖尿病和非糖尿病STEMI患者之间的临床预后差异不能通过超声心动图及cTnT峰值所确定的心肌挽救和损伤来解释。合并NTIRDM的STEMI患者MACCE发生率增加。

• Objective  To investigate the effect of diabetes mellitus in patients with ST-segment elevation myocardial infarction (STEMI) on myocardial rescue and injury determined by echocardiography combined with cardiac troponin T (cTnT) peak value and its correlation with prognosis. Methods From August 2017 to August 2020， the clinical data of 792 patients with STEMI admitted to the First Affiliated Hospital of Shantou University Medical College were analyzed retrospectively. All patients were divided into diabetes mellitus group (160 cases) and non diabetes mellitus group (632 cases) according to whether they were complicated with diabetes mellitus. The patients in diabetes mellitus group were divided into TIRDM group ［time in range(TIR)≥70%, up to standard, 74 cases］ and NTIRDM group (TIR＜70%, not up to standard, 86 cases) according to whether the TIR of glucose was up to standard or not. The occurrence of major adverse cardio-cerebral vascular events (MACCE), the echocardiographic indexes and the level of cTnT peak value in each group were compared. Kaplan-Meier method was used to compare the risk of MACCE in each group. Cox regression method was used to analyze the related factors of MACCE. ResultsA total of 53 patients (6.7%) had MACCE during a 24-month follow-up period. Kaplan-Meier analysis showed that the risk of MACCE in the diabetes mellitus group was higher than that in the non diabetes mellitus group (Log-rank P=0.02). The risk of MACCE in NTIRDM group was higher than that in TIRDM group and non diabetes mellitus group (Log-rank P＜0.01). Multivariate Cox regression analysis showed that NTIRDM (odds ratio=2.24, 95% confidence interval: 1.09-4.62, P=0.03) was associated with MACCE in STEMI patients. There were no significant differences in echocardiographic indexes and the level of cTnT peak value among TIRDM group, NTIRDM group and non diabetes mellitus group (all P＞0.05). Conclusions The differences in clinical prognosis between diabetes mellitus and non diabetes mellitus patients with STEMI cannot be explained by myocardial rescue and injury determined by echocardiography and cTnT peak value. The incidence of MACCE increases in patients with STEMI complicated with NTIRDM.