Lancet Diab & Endo：强化降糖降心梗糖尿病患者死亡率（DIGAMI1研究）

2014-05-14 CMT 中国医学论坛报CMT心血管微信

瑞典学者研究发现，对于发生急性心梗和入院时存在高糖血症的糖尿病患者，强化血糖控制对其生存时间有长期影响。论文5月13日在线发表于《柳叶刀糖尿病与内分泌学》(Lancet Diabetes Endocrinol)杂志。该项名为DIGAMI1的研究纳入620例先前有或未被诊为糖尿病、血糖浓度>11 mmol/L、过去24小时有可疑急性心梗的患者，患者被随机(1:1)分为以胰岛素为基础的强化血

瑞典学者研究发现，对于发生急性心梗和入院时存在高糖血症的糖尿病患者，强化血糖控制对其生存时间有长期影响。论文5月13日在线发表于《柳叶刀糖尿病与内分泌学》(Lancet Diabetes Endocrinol)杂志。

该项名为DIGAMI1的研究纳入620例先前有或未被诊为糖尿病、血糖浓度>11 mmol/L、过去24小时有可疑急性心梗的患者，患者被随机(1:1)分为以胰岛素为基础的强化血糖控制组(n=306)和常规降糖治疗对照组(n=314)。主要研究终点为死亡率(包括起始研究中以及随后的随访研究中发生的死亡)。

结果为，在平均为7.3年的随访期间，强化血糖治疗组和常规降血糖组分别有271例(89%)和285例(91%)患者死亡，两组患者的中位生存时间分别为7.0年和4.7年(P=0.027)。在随机研究开始后的8年间，强化血糖控制的影响很显著，使生存时间增加2.3年。

美国国家心肺与血液研究所邦兹(Bonds)评论：30年前，一位因急性心梗入院的糖尿病患者在随后1年中的死亡几率超过1/4，仅有的血糖控制药物只有胰岛素、磺脲类药物和二甲双胍。之前，没有证据支持非胰岛素依赖的糖尿病患者接受强化血糖治疗有益，鉴于此背景下，被简称为DIGAMI 1，即在心梗时糖尿病胰岛素输注试验，开始了。

上述研究经历20年的随访(平均7.3年)后得出的结论是：与常规降血糖治疗相比，强化血糖控制可以使患者多活2.3年。初看，DIGAMI 1的结果似乎与ACCORD、ADVANCE和 VADT等近期发布的研究结果不一致，是否DIGAMI 1研究是个另类，或者其预示了上述3项研究经长期随访后将会得到的结果呢?

真相是否定的。其原因在于DIGAMI 1研究与其他研究中可利用的治疗手段与治疗目标间存在显著差异。例如，仅有1/3的DIGAMI 1研究患者在出院时接受血管紧张素转换酶抑制剂治疗、没有患者接受他汀治疗。

基于DIGAMI 1研究的结果，临床医师是否应该改变其治疗策略呢?我的答案也是否定的。但同时，DIGAMI 1研究也是有价值的，其价值在于其历史性。首先，该研究指出，即便是诸如血脂、血压等其他危险因素不能或者没有被控制，控制血糖也是有益的;其次，该研究还提醒我们，在过去20年中，药物治疗取得了多么大的进展。

原始出处：

Viveca Ritsinger, Klas Malmberg, Anton Mårtensson c, Lars Rydén, Hans Wedel, Anna Norhammar.Intensified insulin-based glycaemic control after myocardial infarction: mortality during 20 year follow-up of the randomised Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction (DIGAMI 1) trial.The Lancet Diabetes & Endocrinology, May 13 2014 doi:10.1016/S2213-8587(14)70088-9Cite

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2014-07-19 dongjia2010

#强化降糖#

85 0
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2014-06-23 howi

#Lancet#

51 0
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2014-10-12 ms9608593228839890

#DIA#

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2015-01-06 sunylz

#患者死亡#

0 0
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2014-05-16 xue8604

#糖尿病患者#

72 0
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2014-05-16 yibei

#IgA#

61 0

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Lancet Diab & Endo：强化降糖降心梗糖尿病患者死亡率（DIGAMI1研究）

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