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Acta medica Medianae
2012, vol. 51, br. 3, str. 18-23
jezik rada: engleski
vrsta rada: izvorni naučni članak

Uticaj hiperglikemije usled stresa na ishod bolničkog lečenja bolesnika sa akutnim infarktom miokarda sa ST elevacijom
aCardiovascular Clinic, Clinical Center, Niš
bUniverzitet u Kragujevcu, Medicinski fakultet
cUniverzitet u Nišu, Medicinski fakultet

Sažetak

Povišena glikemija pri prijemu, u brojnim urgentnim stanjima, uključujući akutni infarkt miokarda (AIM), pogoršava ishod lečenja bez obzira na savremenu terapiju. Uvođenjem primarne perkutane koronarne intervencije (PPCI) u terapiju AIM sa ST segment-elevacijom (STEMI) poboljšano je lečenje ove grupe bolesnika. Kontradiktorna su saopštenja u literaturi oko uticaja hiperglikemije usled stresa na ishod lečenja, pa je cilj istraživanja bio analiza uticaja hiperglikemije usled stresa na hospitalnu prognozu bolesnika sa AIM-STEMI lečenih PPCI. Prospektivnim istraživanjem obuhvaćeno je 116 bolesnika sa dijagnozom prvog AIM-STEMI koji su lečeni PPCI-om u Klinici za kardiovaskularne bolesti KC Niš u periodu 2010-2011. godine. Odmah po postavljanju dijagnoze, bolesnici su uz adekvatnu medikamentnu pripremu uvođeni u salu za angiografiju, gde im je rađena koronarografija sa ugradnjom stenta. Laboratorijske analize iz pune krvi rađene su odmah po prijemu i sledeće jutro. Receiver-operator characteristic (ROC) analizom pokazano je da je najbolja vrednost hiperglikemije usled stresa pri prijemu, za razgraničavanje onih koji će preživeti i onih koji će umreti u bolnici, 11.2 mmol/L, sa površinom ispod krivulje 0.812. U grupi bez hiperglikemije usled stresa umrlo je približno pet puta manje bolesnika (1/79-1.2%) nego u grupi sa hiperglikemijom usled stresa (5/37 -13.5%), p=0.041. Prisustvo hiperglikemije je podjednako loše uticalo na prognozu bolesnika bez obzira na prisustvo ili odsustvo dijabetes melitusa. Smrtnost u grupi bez DM sa hiperglikemijom ili bez nje bila je slična (3/26 vs. 1/54, ns) kao i u grupi sa DM (1/11 vs. 1/25, ns). Najbolja granična (cut-off) vrednost za hiperglikemiju usled stresa kod bolesnika sa AIM STEMI lečenih PPCI je 11.2mmol/L, dobijena je ROC krivom, a determiniše značajan gradijent rizika: bolesnici sa glikemijom <11.2mmol/L pri prijemu imali su skoro pet puta manji rizik od umiranja u bolnici od onih sa koncentracijom glikoze ≥11.2mmol/L. Pojava hiperglikemije usled stresa podjednako je loše uticala na bolničko preživljavanje u grupama sa i bez DM.

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