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3 C Logistic >7mmol/L 3 7mmol/L

4 10.6% vs 8% 38.3% vs14.1% P< % vs12.1% P< C [ ]

5 Abstract In-hospital Prognostic Value of Blood Glucose in Patients with Acute Myocardial Infarction and the changes of Stress Hormones Postgraduate: Cheng Chen Supervisor: Prof. Xiaohui Guo Peking University First Hospital Department of Endocrinology OBJECTIVES: To assess the effect of diabetes mellitus (DM) and admission hyperglycemia on outcomes in patients with acute myocardial infarction (AMI). To investigate the changes of stress hormones during the acute period of AMI and the effect of it on glucose. METHODS: Part one: The medical records of 146 adult patients admitted to CCU with AMI in Beijing University First Hospital from Feb 2002 to Dec 2003 were reviewed. They were divided into two groups according to the history of DM or the admission glucose. Of 146 patients, 47(32.2%) had history of diabetes mellitus. The in-hospital mortality the rates of heart failure and infection were compared between the groups with and without DM. Part two: We studied 32 patients with AMI. Following the level of admission glucose and glycosylated haemoglobin subjects were classified as (1) diabetes(n=12): diagnosed diabetes before admission; (2) stress hyperglycemia (n=12): admission glucose 7mmol/L and HbA1c is normal, without diagnosed diabetes ; (3) normal glucose (n=8):

6 admission glucose <7mmol/L without diabetes. We compared the differences on glucose and stress hormone (cortisol and catecholamine) among these three groups. RESULTS: Part one: Among patients with diabetes the in-hospital mortality rate was 10.6% vs 8% for non-diabetic patients but it was no significant the rates of heart failure and infection were higher in the patients with diabetes than non-diabetic patients: 38.3% vs 14.1% and 27.7% vs 12.1% P<0.05. Backward Logistic regression analysed the high blood glucose on admission is bad prognostic indicator in patients with acute myocardial infarction. Part two : the admission level of cortisol and catecholamine was higher than control but there was no significant difference among the groups of diabetes stress hyperglycemia and normal glucose. The level of C peptide in patients increased especially among the patients with normal glucose. CONCLUSIONS: Hyperglycemia might be associated with poor inhospital prognosis among patients after acute myocardial infarction. There was the same response to stress in patients with diabetes stress hyperglycemia and normal glucose. The patients with stress hyperglycemia might have impaired β cell function. [Key words]: AMI Hyperglycemia Stress Prognosis

7 1.1 [1] 30% [2] 7 3.5% 18.8% % 45% 2 [3] % [4] % [5] % [6] % [7] % % % p <0.001 [8] Rytter 9.7%vs6.1% [14]

8 1.2 [9] 2 4 [10] 50% 150% 300% [11] [12] %vs19.2% 46.7%vs 37.8% [6] 1 41%vs26% 1 23%vs14% [5] %vs7.4% [13] % % % [14] [15] 49%vs28% [16] [8] [17] [5] [16] [8] Elaine [42] Gwilt [16] [14] 4%

9 85% [19][20] 1.3 Killip [22] Karlson [5] [16] 2 [21] [23] [24][25] [21] %vs6% 91% 83% [8] [26] [8] [27][28][29] PAS(+) [15]

10 Gruikshank [31] >8mmol/L 50% [32][33] 30% 12mmol/L 6.11mmol/L mmol/L 55% [34][35] Sala 4 >6.67mmol/L 69% >6.67mmol/L 47.3% [36] 46%-84% [39] mmol/L [37] GhbA1c<6% > 8.0mmol/L[38] Sarah [54] mmol/L 71% 36%-47% 3% mmol/L 36-43% 47% 5% %-5% 14% [40][27][41] 3 1/5 [42]

11 >6.1mmol/L 2 >7.8mmol/L [34] <6.1mmol/L mmol/L >11.1mmol/L 12.2% 52.78% 75.86% [27] Norman 7.8mmol/L 33% [43] mmol/L 0.55mmol/L >6.67mmol/L % >6.67mmol/L [36] Anna M 7.4mmol/L [30] [40] % 3% 1.7% ICU 31% 3 ( 11% 10%) [41] Capes [44]

12 [45] [46][47] Oliver MF %CI ( ) [39] [33] [48][49] [30] [50] 8mmol/L 4% 11mmol/L 35% [33] 2.5 [30] Killip [22] [48][49] [18][27][39] Oswald [32] 2.3 [36] [41] 2.4 [44]

13 [51] [52] [53] [54] [55][56] - [50] [57] [58] [59]

14 vwf [55][56] [60] mol/l 6.1-8mmol/L 3.1 stress. stress hormones - corticotrophin releasing hormone CRH vasopressin AVP - Y adrenocorticortrophin ACTH - prolactin PRL growth-hormone GH cortisol CORT epinephrine E (norepinephrine NE) dopamine DA [44]

15 3.2 Glucocorticoids (Catecholamines) - - Acute Physiology and Chronic Health Evaluation APACHE 53 ICU ug/dl 39.0ug/dl 12ug/dl [44] min 40min 4 2 Glucagon GL [61] 30 (Insulin INS) C C CORT ACTH E NE NE GH GL NE INS C GH

16 [62] p>0.05 ; 294 p<0.01 ; 30 3 [37] ug/l( ); mmol/L( ) mU/l ; ng/l; ug/l( ) [37] 48 T 3 [63] (E: NE:650 67) E:35 4ng/L NE:250 27ng/L E:83 8 NE: [64] > > /25 [65] 3.3.2

864 现代药物与临床 Drugs & Clinic 第 31 卷第 6 期 2016 年 6 月 of apoptosis related factors, decrease the incidence of adverse reactions, which is of great

864 现代药物与临床 Drugs & Clinic 第 31 卷第 6 期 2016 年 6 月 of apoptosis related factors, decrease the incidence of adverse reactions, which is of great 现代药物与临床 Drugs & Clinic 第 31 卷第 6 期 2016 年 6 月 863 曲妥珠单抗联合多西紫杉醇治疗 Her-2 阳性乳腺癌的临床研究 * 周永安, 刘训碧黄石市中心医院 ( 普爱院区 ) 乳腺肿瘤外科, 湖北黄石 435000 摘要 : 目的探析注射用曲