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1、急性心肌梗死高血糖的控制中山大学附属第一医院内分泌科肖海鹏欧洲心脏调查结果-分组n=2107n=2854TheEuroHeartSurveyondiabetesandtheheart，EuropeanHeartJournal(2004)25,1880–1890GAMI:急性心梗患者中的糖代谢异常心肌梗死患者BartnikM,etal.JInternMed.2004Oct;256(4):288-97.GAMI:新诊断高血糖 是心肌梗死后“无心血管事件存活”的预测因素BartnikM,etal.EurHeartJ.2004;25(22):1990-7.中位数随访时间:34月Diabeticswit
2、hanon-STelevationACShaveaworseoutcomethannondiabeticsIntheOASISregistryof8013patientswithanon-STelevationacutecoronarysyndrome(unstableanginaornonQ-wavemyocardialinfarction),21percenthaddiabetes.Afteratwoyearfollow-up,diabeticpatientshadasignificantlyhighercombinedeventrate(cardiovasculardeath,newmy
3、ocardialinfarction,stroke,newheartfailure)thannondiabetics(relativerisk1.56).DatafromMalmberg,K,Yusuf,S,Gerstein,HC,etal.Circulation2000;102:1014.DiabetesincreasescoronarymortalitywithandwithoutapriorMIInasevenyearfollowupof1059subjectswithtype2diabetesand1378nondiabetics,diabeticswithorwithoutaprio
4、rmyocardialinfarction(MI)hadagreatermortalityfromcoronarydiseasecomparedtonondiabetics(42versus16percentforthosewithapriorMIand15versus2percentforthosewithoutapriorMI.TherateofcoronarydeathandfatalandnonfatalMIindiabeticswithoutapriorMIwasthesameasinnondiabeticswithapriorMI,providingpartoftherationa
5、leforconsideringtype2diabetesacoronaryequivalent.DatafromHaffner,SM,Lehto,S,Ronnemaa,T,etal,NEnglJMed1998;339:229.HyperglycemiaandOutcomeAfterAcuteMIPredictiveValueofAdmissionGlucoseFastingglucosewithin24hrsofadmissionHbA1conadmissionU-shapedcurveIntensiveinsulintherapyreducesmortalityinpatientswith
6、diabetesaftermyocardialinfarctionTheDiabetesMellitus,InsulinGlucoseInfusioninAcuteMyocardialInfarction(DIGAMI)trialrandomlyassigned620diabeticpatientstoroutinecare(controlgroup)orintensivetherapywithacontinuousinsulininfusion.Afteranaveragefollowupof3.4years,themortalityinthecontrolgroupwasdirectlyr
7、elatedtotheadmissionbloodglucoseconcentration(234mg/dL[13mmol/L],>234to297mg/dL[13to16.5mmol/L],and>297mg/dL[16.5mmol/L])(p<0.001).Themortalityinthosetreatedwithintensiveinsulinwassignificantlyreduced
