【摘要】 目的:探讨在围手术期应用胰高血糖素样肽(GLP)-1与胰岛素对ST段抬高型心肌梗死(STEMI)合并应激性高血糖患者进行干预,比较两种干预方法对患者心肌灌注及预后的影响。方法:本研究为前瞻性、单中心、随机对照研究,连续入选首次发生STEMI并于12 h内接受急诊经皮冠状动脉介入治疗且入院即刻血糖≥11.1 mmol/L的非糖尿病患者114例,利用随机数字表分为观察组(GLP-1干预,59例)和对照组(胰岛素干预,55例)。对比两组术后心肌灌注、心肌损伤指标、心功能指标及心肌梗死面积(MIA)、心肌挽救指数(MSI),随访6个月,记录两组心血管不良事件(MACE)情况。结果:观察组围手术期肌酸激酶同工酶及心肌肌钙蛋白T的峰值较对照组降低(P<0.05);术后6个月,观察组心肌灌注、左心室射血分数均高于对照组(P<0.05),同时观察组较对照组患者MIA减少[(15±12)g vs(20±14)g,P<0.05],MSI增加12%(0.64±0.13 vs 0.56±0.12,P<0.001),但MACE发生差异无统计学意义(P=0.217)。结论:STEMI患者合并应激性高血糖,围手术期应用GLP-1可以在安全调节血糖的同时,逐步改善心肌灌注及心脏功能,减少MIA,但未发现其对围手术期的心肌灌注及6个月MACE发生产生影响。更多还原

【Abstract】 Objective: To explore the peri-operative application of GLP-1 analogue and insulin on myocardial perfusion and clinical prognosis in patients of acute ST segment elevation myocardial infarction(STEMI) with stress-induced hyperglycemia.Methods: Our research was a prospective single center randomized control study. A total of 114 consecutive STEMI patients received percutaneous coronary intervention(PCI) within 12 h of onset were enrolled, the patients had no diabetes while blood glucose ≥11.1mmol/L at immediate admission. Based on random number table, the patients were divided into 2 groups: Observation group, the patients received GLP-1 analogue, n =59 and Control group, the patients received insulin, n =55. The post-operative myocardial perfusion, indicators of myocardial damage and cardiac function, myocardial infarct area(MIA) and myocardial salvage index(MSI) were compared between 2 groups. The patients were followed-up for 6 months to record the incidence of major adverse cardiovascular events(MACE). Results: At peri-operative period, compared with Control group, Observation group had decreased peak values of creatine kinase isoenzyme(CK-MB) and troponin T(cTnT), P <0.05. At 6 months post-operation, compared with Control group, Observation group showed increased myocardial perfusion and left ventricular ejection fraction(LVEF), P <0.05, reduced MIA(15±12) g vs(20±14) g, P <0.05 and 12% elevated MSI as(0.64±0.13) vs(0.56±0.12), P <0.001. The MACE incidence was similar between 2 groups, P =0.217.Conclusion: In STEMI patients with stress-induced hyperglycemia, peri-operative application of GLP-1 analogue may safely regulate blood glucose, improve cardiac perfusion and function, reduce MIA; while it had no influence on myocardial perfusion at peri-operative period and no impact on MACE occurrence at 6 months post-operation.更多还原