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【文摘发布】急性冠脉综合征患者非糖尿病性高
C Weston1, L Walker2, J Birkhead2 National Audit of Myocardial Infarction Project, National Institute for Clinical Outcomes Research
1 Singleton Hospital, Swansea, UK
2 National Institute for Clinical Outcomes Research, The Heart Hospital, London, UK
ABSTRACT
Objective: To determine the effect of insulin for the management of hyperglycaemia in non-diabetic patients presenting with acute coronary syndrome.
Methods: An observational study from the MINAP (National Audit of Myocardial Infarction Project) database during 2003–5 in 201 hospitals in England and Wales. Patients were those with a final diagnosis of troponin-positive acute coronary syndrome who were not previously known to have diabetes mellitus and whose blood glucose on admission was 11 mmol/l. The main outcome measure was death at 7 and 30 days.
Results: Of 38 864 patients who were not previously known to be diabetic, 3835 (9.9%) had an admission glucose 11 mmol/l. Of patients having a clear treatment strategy, 36% received diabetic treatment (31% with insulin). Mortality at 7 and 30 days was 11.6% and 15.8%, respectively, for those receiving insulin, and 16.5% and 22.1%, respectively, for those who did not. Compared with those who received insulin, after adjustment for age, gender, co-morbidities and admission blood glucose concentration, patients who were not treated with insulin had a relative increased risk of death of 56% at 7 days and 51% at 30 days (HR 1.56, 95% CI 1.22 to 2.0, p<0.001 at 7 days; HR 1.51, 95% CI 1.22 to 1.86, p<0.001 at 30 days).
Conclusion: In non-diabetic patients with acute coronary syndrome and hyperglycaemia, treatment with insulin was associated with a reduction in the relative risk of death, evident within 7 days of admission, which persists at 30 days.
Heart 2007; 93: 1542-1546
http://heart.bmj.com/cgi/content/abstract/93/12/1542 本人认领此文章，24小时交稿。24小时后若未提交译文，请其他战友自由认领 Early impact of insulin treatment on mortality for hyperglycaemic patients without known diabetes who present with an acute coronary syndrome
急性冠脉综合征患者非糖尿病性高血糖状态早期应用胰岛素对死亡率的影响
C Weston1, L Walker2, J Birkhead2 National Audit of Myocardial Infarction Project, National Institute for Clinical Outcomes Research
1 Singleton Hospital, Swansea, UK
2 National Institute for Clinical Outcomes Research, The Heart Hospital, London, UK
ABSTRACT
Objective: To determine the effect of insulin for the management of hyperglycaemia in non-diabetic patients presenting with acute coronary syndrome.
目的：观察胰岛素对患有急性冠脉综合征的非糖尿病患者高血糖的治疗效果。
Methods: An observational study from the MINAP (National Audit of Myocardial Infarction Project) database during 2003–5 in 201 hospitals in England and Wales. Patients were those with a final diagnosis of troponin-positive acute coronary syndrome who were not previously known to have diabetes mellitus and whose blood glucose on admission was 11 mmol/l. The main outcome measure was death at 7 and 30 days.
方法：实验对2003年到2005年英格兰和威尔士的201所医院中的患者（数据来源于MINAP）进行了一项观察性研究。所选的患者为最终诊断为肌钙蛋白阳性的急性冠脉综合症患者，这些患者既往无糖尿病史，入院时血糖为11 mmol/l。评定实验结果的主要方法为7天和30天死亡。
Results: Of 38 864 patients who were not previously known to be diabetic, 3835 (9.9%) had an admission glucose 11 mmol/l. Of patients having a clear treatment strategy, 36% received diabetic treatment (31% with insulin). Mortality at 7 and 30 days was 11.6% and 15.8%, respectively, for those receiving insulin, and 16.5% and 22.1%, respectively, for those who did not. Compared with those who received insulin, after adjustment for age, gender, co-morbidities and admission blood glucose concentration, patients who were not treated with insulin had a relative increased risk of death of 56% at 7 days and 51% at 30 days (HR 1.56, 95% CI 1.22 to 2.0, p<0.001 at 7 days; HR 1.51, 95% CI 1.22 to 1.86, p<0.001 at 30 days).
结果：在总共38864名无糖尿病史的患者中，3835 (9.9%)名入院血糖为11 mmol/l。对于有明确治疗策略的患者中，36%接受了糖尿病治疗（其中31%使用了胰岛素）。接受胰岛素治疗的患者中，7天和30天死亡率分别为11.6%和15.8%，而未接受胰岛素治疗的患者分别为16.5% 和22.1。除去年龄、性别、并存病和入院血糖的因素，未接受胰岛素治疗的患者7天和30天死亡的风险均有增加，分别为56%和51%（ 7 天时，HR 1.56, 95% CI 1.22 to 2.0, p<0.001 ; 30天时HR 1.51, 95% CI 1.22 to 1.86, p<0.001 ）。
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作者:admin@医学,生命科学 2011-03-09 17:11
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