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Valor prognóstico da hiperglicemia na admissão hospitalar de síndromes coronárias agudas
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Resumo(s)
A hiperglicemia é um achado frequente na admissão hospitalar de doentes com Síndromes Coronárias Agudas (SCA) independentemente do diagnóstico prévio de Diabetes Mellitus (DM). Vários estudos demonstraram haver uma relação estatisticamente significativa entre a presença de hiperglicemia e o pior prognóstico a curto e longo prazo nos doentes com SCA. Perante o reconhecimento desta relação, vários autores procuraram encontrar soluções terapêuticas que pudessem reverter o efeito da hiperglicemia e, assim, melhorar o prognóstico. A hiperglicemia tem consequências em vários processos celulares que podem justificar o pior prognóstico em doentes com SCA, nomeadamente nas vias da coagulação, no estado inflamatório e na função endotelial. No entanto, existem ainda algumas dúvidas quanto ao valor a partir do qual é considerado hiperglicemia na admissão hospitalar, o valor alvo da glicemia para o controlo metabólico e as medidas terapêuticas a serem implementadas.
Hyperglycemia is a common finding in hospital admission of patients with Acute Coronary Syndromes (ACS) regardless of prior diagnosis of diabetes mellitus (DM). Several studies have demonstrated a statistically significant relationship between the presence of hyperglycemia and poor prognosis in the short and long term in patients with ACS. In view of the recognition of this relationship, several authors have tried to find therapeutic solutions that could reverse the effect of hyperglycemia and, thus, improve the prognosis. Hyperglycemia has effects on several cellular processes that can justify the worst prognosis in patients with ACS, particularly in the coagulation pathways in the inflammatory state and endothelial function. However, there are still some doubts as to the value from which is considered hyperglycemia on admission, the target value of blood glucose for metabolic control and therapeutic measures to be implemented.
Hyperglycemia is a common finding in hospital admission of patients with Acute Coronary Syndromes (ACS) regardless of prior diagnosis of diabetes mellitus (DM). Several studies have demonstrated a statistically significant relationship between the presence of hyperglycemia and poor prognosis in the short and long term in patients with ACS. In view of the recognition of this relationship, several authors have tried to find therapeutic solutions that could reverse the effect of hyperglycemia and, thus, improve the prognosis. Hyperglycemia has effects on several cellular processes that can justify the worst prognosis in patients with ACS, particularly in the coagulation pathways in the inflammatory state and endothelial function. However, there are still some doubts as to the value from which is considered hyperglycemia on admission, the target value of blood glucose for metabolic control and therapeutic measures to be implemented.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016
Palavras-chave
Hiperglicemia Síndromes coronárias agudas Valor prognóstico Cardiologia