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目的探讨糖尿病合并急性心肌梗死(AMI)患者住院期间血糖波动的变化及意义。方法以性别、年龄及HbA_1c水平进行1:1配对的糖尿病合并AMI患者(AMI组)和糖尿病合并稳定性冠心病患者(CAD组)各30例,通过动态血糖监测技术获得患者住院期间血糖波动参数并比较。结果 (1)AMI组与CAD组比,日内平均血糖波动幅度[MAGE,(3.83±1.38)vs(3.17±1.14)mmol/L]、日间血糖平均绝对差[MODD,(2.62±1.08)vs(2.00±0.90)mmol/L]、餐后血糖波动幅度[PPGE,(3.43±1.70)vs(2.34±1.64)mmol/L二和餐后3 h平均血糖水平[3 h MPBG,(10.49±2.44)vs(8.95±2.45)mmol/L]均升高(P<0.05),平均血糖标准差有升高趋势[SDBG,(2.53±1.02)vs(2.16±0.85)mmol/L,P=0.051]。(2)多因素逐步回归分析显示AMI组中MAGE是独立于射血分数和年龄影响全球急性冠状动脉事件(GRACE)积分的危险因子。结论糖尿病合并冠心病患者发生AMI时,其住院期间的日内、日间和餐后血糖波动幅度均明显增大,MAGE还可能有助于评估患者的预后。
Objective To investigate the changes and significance of blood glucose during hospitalization in diabetic patients with acute myocardial infarction (AMI). Methods 30 AMI patients (AMI group) and 30 patients with diabetes mellitus and stable coronary artery disease (CAD group) were enrolled in this study. Their blood glucose fluctuation parameters during hospitalization were obtained by dynamic glucose monitoring And compare. Results The mean intraday blood glucose fluctuation (MAGE, (3.83 ± 1.38) vs (3.17 ± 1.14) mmol / L] in the AMI group and the CAD group were significantly lower than those in the CAD group [MODD (2.62 ± 1.08 vs (2.00 ± 0.90) mmol / L], postprandial blood glucose fluctuation [PPGE, (3.43 ± 1.70) vs (2.34 ± 1.64) mmol / L and postprandial 3h average blood glucose level [3 h MPBG, (10.49 ± 2.44 (P <0.05), mean standard deviation (SDBG, (2.53 ± 1.02) vs (2.16 ± 0.85) mmol / L, P = 0.051] . (2) Multivariate stepwise regression analysis showed that MAGE in AMI group was a risk factor that independent of ejection fraction and age affect global acute coronary event (GRACE) score. Conclusion AMI in patients with diabetes mellitus and coronary heart disease during the hospital stay during the day, day and postprandial blood glucose fluctuations were significantly increased, MAGE may also help to assess the prognosis of patients.