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目的分析影响糖尿病合并急性心肌梗死患者死亡的危险因素。方法对2002年1月1日至2007年9月1日入住本院的糖尿病合并急性心肌梗死患者共104例进行了回顾性分析。其中住院期间死亡患者21例,平均年龄(76±8)岁。存活患者83例,年龄(69±12)岁。对所有入院患者空腹血糖及血脂代谢、肾功能等生化指标进行检测,部分患者接受了经皮冠状动脉介入治疗(PCI),部分患者因血管病变较重或拒绝行PCI术而仅进行了冠脉造影检查。应用Logistic回归分析对影响死亡的相关因素进行统计分析。结果死亡组和存活组之间年龄、空腹血糖(FPG)、血清肌酐(Scr)、心功能分级以及是否接受PCI治疗之间存在显著差异,死亡组年龄、FPG及Scr值均显著高于存活组,存活组接受PCI治疗者多于死亡组(P<0.05),且死亡组心功能分级普遍低于存活组(P<0.01);Logistic回归分析显示心力衰竭及心源性休克是对糖尿病合并急性心肌梗死住院期间死亡患者的发生有显著影响的因素;而性别、年龄、空腹血糖虽然不直接促成糖尿病合并急性心肌梗死患者住院期间发生死亡,但它们对发生心力衰竭或心源性休克有明显影响。结论年龄、空腹血糖可以影响糖尿病合并急性心肌患者的心功能,从而可能间接促成患者住院期间发生死亡。
Objective To analyze the risk factors of death in diabetic patients with acute myocardial infarction. Methods A total of 104 patients with diabetes mellitus complicated with acute myocardial infarction admitted to our hospital from January 1, 2002 to September 1, 2007 were retrospectively analyzed. 21 patients died during hospitalization, the average age (76 ± 8) years old. 83 patients survived, age (69 ± 12) years old. Fasting blood glucose and blood lipid metabolism, renal function and other biochemical parameters were detected in all hospitalized patients. Some patients underwent percutaneous coronary intervention (PCI). Some patients only had coronary artery due to severe vascular disease or refused PCI Contrast examination. Logistic regression analysis was used to analyze the related factors affecting death. Results There were significant differences in age, fasting blood glucose (FPG), serum creatinine (Scr), grade of cardiac function and PCI between the death group and the survival group. The age, FPG and Scr in the death group were significantly higher than those in the survival group (P <0.05), and the cardiac function grade in death group was generally lower than that in survival group (P <0.01). Logistic regression analysis showed that heart failure and cardiogenic shock were associated with acute complications of diabetes mellitus Myocardial infarction patients died during hospitalization had a significant impact on factors; while gender, age, fasting blood glucose although not directly contribute to the death of diabetic patients with acute myocardial infarction during hospitalization, but they have a significant impact on the occurrence of heart failure or cardiogenic shock . Conclusion Age and fasting blood glucose can affect the cardiac function of diabetic patients with acute myocardial infarction, which may indirectly lead to death during hospitalization.