{"id":116200,"date":"2018-03-11T10:45:07","date_gmt":"2018-03-11T10:45:07","guid":{"rendered":""},"modified":"2018-03-11T10:45:07","modified_gmt":"2018-03-11T10:45:07","slug":"alteraciones-del-metabolismo-hidrocarbonado-en-pacientes-con-infarto-agudo-de-miocardio-valor-pronostico-de-la-hemoglobina-glicosilada-y-papel-en-la-prediccion-del-desarrollo-de-alteraciones-de-la-re","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/medicina-interna\/alteraciones-del-metabolismo-hidrocarbonado-en-pacientes-con-infarto-agudo-de-miocardio-valor-pronostico-de-la-hemoglobina-glicosilada-y-papel-en-la-prediccion-del-desarrollo-de-alteraciones-de-la-re\/","title":{"rendered":"Alteraciones del metabolismo hidrocarbonado en pacientes con infarto agudo de miocardio. valor pron\u00f3stico de la hemoglobina glicosilada y papel en la predicci\u00f3n del desarrollo de alteraciones de la regulaci\u00f3n de la glucosa"},"content":{"rendered":"

Tesis doctoral de Jos\u00e9 Higinio De Gea Garcia <\/strong><\/h2>\n

Introduccion las alteraciones del metabolismo hidrocarbonado (mhc) no conocidas previamente, incluida la diabetes mellitus (dm) son frecuentes en los pacientes con infarto agudo de miocardio (iam) y es importante su detecci\u00f3n precoz ya que puede mejorar el pron\u00f3stico. De esta forma, en un ingreso por un iam no debiera perderse la oportunidad de establecerse el diagn\u00f3stico y el subsiguiente inicio del tratamiento. Desafortunadamente, la estrategia \u00f3ptima para identificar las alteraciones del mhc en el contexto de un iam no est\u00e1 totalmente establecida. objetivos los objetivos principales del presente estudio fueron dirigidos a verificar la hip\u00f3tesis de que la determinaci\u00f3n precoz de la hemoglobina glicosilada (hba1c) en pacientes con iam es relevante: –\ten la caracterizaci\u00f3n pron\u00f3stica tanto en los pacientes con dm conocida, de novo o en los pacientes sin dm. –\tuna mejor identificaci\u00f3n de la dm no conocida en los pacientes que ingresan por iam. –\tidentificaci\u00f3n de aquellos pacientes que en ausencia de una alteraci\u00f3n del mhc al ingreso son propensos a desarrollarla ulteriormente. material y m\u00e9todos estudio observacional, prospectivo y longitudinal de los pacientes que ingresaron en la unidad coronaria del hospital cl\u00ednico universitario virgen de la arrixaca (murcia) con el diagn\u00f3stico de iam. El periodo de estudio comprende desde enero de 1999 hasta enero de 2008. al ingreso se recogieron variables cl\u00ednicas y anal\u00edticas, incluyendo la hba1c. Se realiz\u00f3 un seguimiento convencional a largo plazo de los pacientes para conocer su evoluci\u00f3n y si hab\u00edan desarrollado alguna alteraci\u00f3n del mhc. A un subgrupo de pacientes se les realiz\u00f3 al a\u00f1o del iam una sobrecarga oral de glucosa (sog) para un estudio detallado del metabolismo de la glucosa. resultados durante el periodo de estudio ingresaron 1.795 pacientes por un iam. Entre todos los pacientes, 622 presentaban dm previamente conocida y en 159 casos se estableci\u00f3 el diagn\u00f3stico de dm de novo utilizando una hba1c% al ingreso ?6,5%. A los pacientes sin alteraci\u00f3n del mhc (1.014), y una vez excluidos los fallecidos, se les realiz\u00f3 un seguimiento de aproximadamente 7 a\u00f1os. De los 951 pacientes estudiados, en 126 casos se confirm\u00f3 el diagn\u00f3stico de dm, en 766 casos no hab\u00edan sido diagnosticados de dm ni refirieron estar siendo tratados, mientras que en los 59 restantes no dispusimos de datos suficientes para documentar la existencia de alg\u00fan grado de alteraci\u00f3n del mhc. en el subgrupo de pacientes, 138, que se les realiz\u00f3 la sog: 38 presentaron un mhc normal y el resto fueron clasificados como 38 con alteraci\u00f3n de la glucosa en ayunas, 39 con intolerancia a la glucosa y 23 con dm. tras los an\u00e1lisis realizados, en nuestro estudio, la hba1c al ingreso se asoci\u00f3 independientemente con: –\tla aparici\u00f3n de dm en los pacientes a los que se les realiz\u00f3 un seguimiento convencional (or:2,62, p<0,001). –\tla aparici\u00f3n de dm entre aquellos pacientes que se les realiz\u00f3 una sog al a\u00f1o del iam (or:7,28, p=0,009). –\tla mortalidad en todos los pacientes independientemente de la situaci\u00f3n metab\u00f3lica al ingreso. conclusiones el presente estudio confirma la alta preValencia de las alteraciones del mhc en la regi\u00f3n de murcia entre los pacientes que presentan un iam, tanto de dm previamente conocida como de novo. As\u00ed mismo, de nuestros hallazgos se desprende la utilidad de la hba1c en la identificaci\u00f3n de pacientes con dm de novo con un valor igual o superior a 6,5%. Por \u00faltimo, nuestro estudio evidencia que la hba1c en el momento del ingreso, se asocia de forma independiente con la mortalidad a largo plazo (en pacientes con o sin dm, y en aquellos con dm de novo al ingreso) y la ulterior aparici\u00f3n de dm. introduction previously unknown disorders in carbohydrate metabolism (mhc), including diabetes mellitus (dm), are common in patients with acute myocardial infarction (ami), and thus early detection is important because it can improve the prognosis. Also, in an income for ami should not be missed the opportunity to establish the diagnosis and the subsequent treatment initiation. Unfortunately, the optimal strategy for identifying mhc disorders in a context of ami, is not fully established. objectives this study was designed to test the hypothesis that early determination of glycosylated hemoglobin (hba1c) in patients with ami is relevant and useful through the following: –\tin the prognostic characterization both in patients with known dm, de novo, or in patients without dm. –\tbetter identification of the unknown dm in patients admitted for ami. –\tidentification of patients that in the absence of mhc disorder are subsequently prone to develop the disease. material and methods observational, prospective, longitudinal study of patients admitted to the coronary care unit of the clinical hospital universitario virgen de la arrixaca (murcia) with the diagnosis of ami, over a study period of january 1999 to january 2008. at admission clinical and laboratory variables were recorded, including hba1c. Conventional long-term follow-up of patients was done in order to evaluate the changes and determine whether they had developed any alteration of mhc. A year after the ami, a subgroup of patients underwent an oral glucose tolerance test (ogtt) for a detailed study of glucose metabolism. results during the study period, 1,795 patients were admitted for ami. Of these, 622 had previously been diagnosed with dm and in 159 cases the diagnosis of dm was established de novo using hba1c (? 6.5% at admission). Patients without alteration of mhc (1,014), and excluding the deceased, were monitored for about 7 years. Of the 951 patients studied, 126 cases of dm diagnosis were confirmed; in 766 cases dm had been diagnosed or reported to be being treated, while the remaining 59 did not provide sufficient data to document the existence of some degree of alteration of mhc. in the subgroup of patients, for 138 who underwent ogtt, 38 had normal mhc and the rest were classified as 38 with impaired fasting glucose, 39 with glucose intolerance, and 23 with dm. following the analysis performed in our study, hba1c at admission was independently associated with: –\tthe appearance of dm in patients who underwent a conventional follow-up (or: 2.62, p < 0.001). –\tthe appearance of dm among patients who underwent ogtt one year after ami (or: 7.28, p = 0.009). –\tthe mortality in all patients regardless of the metabolic status at admission. conclusions this study confirms the high prevalence of abnormal mhc in murcia among patients with ami, both previously known as de novo dm. Our findings indicate the usefulness of hba1c in identifying patients with de novo dm with a value equal to or greater than 6.5%. Finally, our study shows that hba1c at admission was independently associated with long-term mortality (in patients with or without dm and those with de novo dm) and the subsequent development of dm.<\/p>\n

 <\/p>\n

Datos acad\u00e9micos de la tesis doctoral \u00abAlteraciones del metabolismo hidrocarbonado en pacientes con infarto agudo de miocardio. valor pron\u00f3stico de la hemoglobina glicosilada y papel en la predicci\u00f3n del desarrollo de alteraciones de la regulaci\u00f3n de la glucosa<\/strong>\u00ab<\/h3>\n
    \n
  • T\u00edtulo de la tesis:<\/strong>\u00a0 Alteraciones del metabolismo hidrocarbonado en pacientes con infarto agudo de miocardio. valor pron\u00f3stico de la hemoglobina glicosilada y papel en la predicci\u00f3n del desarrollo de alteraciones de la regulaci\u00f3n de la glucosa <\/li>\n
  • Autor:<\/strong>\u00a0 Jos\u00e9 Higinio De Gea Garcia <\/li>\n
  • Universidad:<\/strong>\u00a0 Murcia<\/li>\n
  • Fecha de lectura de la tesis:<\/strong>\u00a0 24\/07\/2014<\/li>\n<\/ul>\n

     <\/p>\n

    Direcci\u00f3n y tribunal<\/h3>\n
      \n
    • Director de la tesis<\/strong>\n
        \n
      • Jose Galcera Tomas<\/li>\n<\/ul>\n<\/li>\n
      • Tribunal<\/strong>\n
          \n
        • Presidente del tribunal: Francisco javier Tebar masso <\/li>\n
        • ram\u00f3n Francisco L\u00f3pez palop (vocal)<\/li>\n
        • Jos\u00e9 Antonio Melgarejo moreno (vocal)<\/li>\n
        • luciano Consuegra s\u00e1nchez (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

           <\/p>\n","protected":false},"excerpt":{"rendered":"

          Tesis doctoral de Jos\u00e9 Higinio De Gea Garcia Introduccion las alteraciones del metabolismo hidrocarbonado (mhc) no conocidas previamente, incluida la […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[932,12132,851,139,8235],"tags":[127184,25099,37045,229506,201704,143722],"class_list":["post-116200","post","type-post","status-publish","format-standard","hentry","category-cardiologia","category-cuidados-intensivos","category-endocrinologia","category-medicina-interna","category-murcia","tag-francisco-javier-tebar-masso","tag-jose-antonio-melgarejo-moreno","tag-jose-galcera-tomas","tag-jose-higinio-de-gea-garcia","tag-luciano-consuegra-sanchez","tag-ramon-francisco-lopez-palop"],"_links":{"self":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/116200","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/comments?post=116200"}],"version-history":[{"count":0,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/116200\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/media?parent=116200"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/categories?post=116200"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/tags?post=116200"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}