2020 年第 5 期 第 15 卷

血糖水平升高对不伴有糖尿病的老年急性心力衰竭患者心功能及预后的影响

Influence of hyperglycemia on cardiac function and prognosis of elderly patients with acute heart failure without diabetes

作者：张兰芳1 贾辛未1 赵淑君1 张继伟1 洪亚宁2 冯丽侠2

英文作者：Zhang Lanfang1 Jia Xinwei1 Zhao Shujun1 Zhang Jiwei1 Hong Yaning2 Feng Lixia2

单位：1河北大学附属医院心血管内科，河北省保定市071000；2河北省保定市高阳县妇幼保健院产科071500

英文单位：1Department of Cardiovascular Medicine Affiliated Hospital of Hebei University Hebei Province Baoding 071000 China; 2Department of Obstetrics Maternal and Children Health Care Hospital of Gaoyang County Hebei Province Baoding 071500 China

关键词：急性心力衰竭；高血糖；心功能；预后 

英文关键词：Acuteheartfailure;Hyperglycemia;Cardiacfunction;Prognosis 

• 摘要：

• 目的 探讨入院时血糖水平升高对不伴有糖尿病的老年急性心力衰竭患者心功能及预后的影响。方法 选取2018年1月至2019年3月河北大学附属医院收治的不伴有糖尿病的老年急性心力衰竭患者60例，根据患者入院时随机血糖水平将其分为血糖正常组(＜7.8 mmol/L，30例)和血糖升高组（≥7.8 mmol/L，30例），均给予相同的常规治疗。入院后测定血清N末端B型脑钠肽前体（NT-proBNP）、左心室舒张末期内径（LVEDD）及左心室射血分数（LVEF），观察住院期间严重心律失常发生率、心源性休克发生率和病死率，院外随访30 d记录因急性心力衰竭再住院率和病死率。结果 入院时血糖升高组患者的血清NT-proBNP水平明显高于血糖正常组［（955±50）ng/L比（208±39）ng/L］，LVEDD明显大于而LVEF明显低于血糖正常组［（5.8±3.1）cm比（4.3±2.2）cm、（45.5±3.1）%比（51.3±2.7）%］，差异均有统计学意义（均P＜0.05）。住院期间血糖升高组的严重心律失常发生率、休克发生率及病死率均明显高于血糖正常组［16.7%（5/30）比3.3%（1/30）、6.7%（2/30）比0、6.7%（2/30）比0］，差异均有统计学意义（均P＜0.05）；出院后随访30 d，血糖升高组再住院率及病死率均明显高于血糖正常组［10.0%（3/30）比3.3%（1/30）、3.3%（1/30）比0］，差异均有统计学意义（均P＜0.05）。结论血糖水平升高的不伴有糖尿病老年急性心力衰竭患者心功能差，不良预后风险高。

• Objective To analyze the effect of hyperglycemia on cardiac function and prognosis of elderly patients with acute heart failure without diabetes. Methods Sixty elderly patients with acute heart failure without diabetes admitted to Affiliated Hospital of Hebei University from January 2018 to March 2019 were tested random blood glucose and divided into normal group(blood glucose＜7.8 mmol/L, 30 cases) and hyperglycemia group（blood glucose≥7.8 mmol/L, 30 cases）. All patients were treated with same conventional therapy. N-terminal pro-B-type natriuretic peptide（NT-proBNP）, left ventricular end-diastolic dimension（LVEDD） and left ventricular ejection fraction（LVEF） were detected after admission. Incidences of severe arrhythmia, cardiac shock and death were observed during hospitalization. Re-hospitalization due to acute heart failure and short-term mortality were observed in 30 days after discharge. Results Level of serum NT-proBNP in hyperglycemia group was significantly higher than that in normalgroup［（955±50）ng/L vs （208±39）ng/L］; LVEDD in hyperglycemia group was greater and LVEF was lower than those in normal group［（5.8±3.1）cm vs （4.3±2.2）cm, （45.5±3.1）% vs （51.3±2.7）%］(all P＜0.05). More severe arrhythmia, cardiac shock and death occurred in hyperglycemia group during hospitalization than those in normal group［16.7%（5/30） vs 3.3%（1/30）, 6.7%（2/30） vs 0, 6.7%（2/30） vs 0］（all P＜0.05）. In 30 days after discharge, re-hospitalization rate and mortality rate in hyperglycemia group were higher than those in normal group［10.0%（3/30） vs 3.3%（1/30）, 3.3%（1/30） vs 0］（both P＜0.05）. ConclusionElevated blood glucose level indicates cardiac function reduction and poor prognosis in elderly patients with acute heart failure without diabetes.