The Korean Journal of Medicine

  • 제87권5호
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  • Pages.565-573
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  • 2014
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

내원시 저혈당이 당뇨병을 동반한 심근경색증 환자의 예후에 미치는 영향

The Influence of Admission Hypoglycemia on Clinical Outcomes in Acute Myocardial Infarction Patients with Diabetes Mellitus

  • 김은정 (전남대학교병원 순환기내과) ;
  • 정명호 (전남대학교병원 순환기내과) ;
  • 정인석 (전남대학교병원 흉부외과) ;
  • 오상기 (전남대학교병원 흉부외과) ;
  • 김상형 (전남대학교병원 흉부외과) ;
  • 안영근 (전남대학교병원 순환기내과) ;
  • 김주한 (전남대학교병원 순환기내과) ;
  • 김영조 (영남대학교병원 순환기내과) ;
  • 채성철 (경북대학교병원 순환기내과) ;
  • 홍택종 (부산대학교병원 순환기내과) ;
  • 성인환 (충남대학교병원 순환기내과) ;
  • 채제건 (전북대학교병원 순환기내과) ;
  • 김종진 (경희대학교병원 순환기내과) ;
  • 조명찬 (충북대학교병원 순환기내과) ;
  • 승기배 (가톨릭대학교 서울성모병원 순환기내과) ;
  • 김효수 (서울대학교병원 순환기내과) ;
  • Kim, Eun Jung (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Jeong, Myung Ho (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Jeong, In Seok (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital) ;
  • Oh, Sang Gi (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital) ;
  • Kim, Sang Hyung (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital) ;
  • Ahn, Young keun (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Kim, Ju Han (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Kim, Young Jo (Department of Cardiovascular Medicine, Yeungnam University Hospital) ;
  • Chae, Shung Chull (Department of Cardiovascular Medicine, Kyungpook National University Hospital) ;
  • Hong, Taek Jong (Department of Cardiovascular Medicine, Department of Cardiovascular Medicine, Pusan National University Hospital) ;
  • Seong, In Whan (Department of Cardiovascular Medicine, Chungnam National University Hospital) ;
  • Chae, Jei Keon (Department of Cardiovascular Medicine, Chunbuk National University Hospital) ;
  • Kim, Chong Jin (Department of Cardiovascular Medicine, KyungHee University Hospital) ;
  • Cho, Myeong Chan (Department of Cardiovascular Medicine, Chungbuk National University Hospital) ;
  • Seung, Ki Bae (Department of Cardiovascular Medicine, The Catholic University of Korea St Mary’s Hospital) ;
  • Kim, Hyo Soo (Department of Cardiovascular Medicine, Seoul National University) ;
  • 투고 : 2013.11.07
  • 심사 : 2014.02.21
  • 발행 : 2014.11.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 당뇨병 환자에게 철저한 혈당 조절은 논란의 여지가 있으며, 이에 당뇨병을 동반한 급성 심근경색증 환자의 내원 시 저혈당과 병원 내 주요 임상 사건 및 사망률 그리고 추적관찰 1년간 사망률과의 관계를 알아보고자 하였다. 방법: 2005년 11월부터 2012년 3월까지 KAMIR에 등록된 당뇨병이 동반된 급성 심근경색증 환자 5,249명을 혈당 수치에 따라서 저혈당을 보인 환자(${\leq}70$ mg/dL)를 I군(93명, $72.6{\pm}11.0$세, 여성 46.2%), 정상혈당을 보인 환자(> 70 and < 140)를 II군(1,262명, $71.3{\pm}10.7$, 여성 34.3%), 고혈당을 보인 환자(${\geq}140$)를 III군(3,894명, $70.3{\pm}11.1$, 여성 36.0%)으로 분류하여, 병원 내 주요 임상사건 및 1년 후 사망률과의 관계를 비교하였다. 결과: 각 군의 평균 연령은 I군($72.6{\pm}11.0$세), II군($71.3{\pm}10.7$세), III군($70.3{\pm}11.1$세)으로 I군에서 연령이 높았다(p = 0.006). I군에서 내원 시 비전형적인 증상 양상(p = 0.002), Killip class III-IV (p = 0.003), 심초음파을 이용한 좌심실 구혈률 40% 미만의 환자(p = 0.002), NSTEMI가 많았다(p = 0.001). 전체 대상 환자 5,249명 중 344명(6.6%)이 입원 중 사망하였으며, 이 중에서 I군 12명(12.9%), II군 66명(5.2%), III군 266명(6.8%)으로 I군에서 사망률이 유의하게 높았다(p = 0.006). 다변량 회귀분석에서 나이(p = 0.001), Killip class III-IV (p = 0.001), 뇌혈관 질환(p = 0.002), 만성 신부전증(p = 0.001), 급성 신부전증(p = 0.001), 심인성 쇼크(p = 0.001), 심실성 빈맥증(p = 0.005), 좌심실 구혈률 40% 미만(p = 0.001), 내원시 혈당 70 mg/dL 미만(p = 0.005)은 추적관찰 한 달간 사망률에 독립적인 예측인자이었다. 정상 혈당군에 비하여 저혈당 군에서 사망률이 유의하게 증가하였고(OR 3.571, 95% CI 1.465-8.705, p = 0.005). 고혈당군에 비해 저혈당군에서 사망률이 유의하게 증가하였다(OR 4.088, 95% CI 1.757-9.511, p = 0.001). 그러나 추적관찰 1년간에서 내원시 혈당은 사망률의 유의한 예측인자가 아니었다(p = 0.428). 결론: 당뇨병을 동반한 심근경색증 환자의 내원 시 저혈당은 입원중과 추적관찰 한 달간의 사망률을 예측할 수 있는 예후인자였다.

Background/Aims: There are controversies surrounding strict control of blood glucose levels in diabetic patients. Therefore, we evaluated the influence of hypoglycemia at admission on the clinical outcomes of patients with acute myocardial infarction (AMI). Methods: We analyzed 5,249 diabetic patients who enrolled in the Korean Acute Myocardial Infarction Registry from November 2005 to March 2013. The patients were divided into three groups according to their blood glucose level at admission; Group I: hypoglycemia (${\leq}70$ mg/dL), Group II: normoglycemia (70-140 mg/dL) and Group III: hyperglycemia (${\geq}140$ mg/dL). We assessed in-hospital mortality and the major adverse cardiac events based on blood glucose levels at admission. Results: The mean age was older in group I at $72.6{\pm}11.0$ years compared to $71.3{\pm}10.7$ in group II and $70.3{\pm}11.1$ in group III (p < 0.006). A total of 344 patients died during hospitalization. In-hospital mortality was higher in group I at 12.9%, compared to 5.2% in group II and 6.8% in group III (p < 0.006). Multivariable logistic regression analysis determined that the independent predictors of 1-month mortality were age, Killip class III-IV, cerebrovascular disease, chronic renal failure, acute renal failure, cardiogenic shock, ventricular tachycardia, ejection fraction < 40% and hypoglycemia in admission. The mortality rate at 1 month was significantly higher in group I compared to group II (odds ratio [OR] 3.571; 95% confidence interval [CI] 1.465-8.705, p = 0.005) compared to group II and group III (OR 4.088; 95% CI 1.757-9.511, p = 0.001). Conclusions: Hypoglycemia on admission was an important predictor of in-hospital and one-month mortality in AMI patients with diabetes mellitus.

키워드

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피인용 문헌

  1. Hypoglycemic Morbidity and Mortality in Diabetes vol.17, pp.1, 2016, https://doi.org/10.4093/jkd.2016.17.1.17