糖化血红蛋白控制达标的急性心肌梗死患者发生应激性高血糖危险因素分析和风险预测模型构建  

Risk factors for stress hyperglycemia in acute myocardial infarction patients whose HbA1c control is up to standard and the establishment of risk prediction model

作　　者：李其华[1] 陈宇[1] 易秋艳[1] 徐广纳 王晓迪 LI Qihua;CHEN Yu;YI Qiuyan;XU Guangna;WANG Xiaodi(Department of General Medicine,Liuzhou People’s Hospital,Liuzhou 545006,China)

机构地区：[1]柳州市人民医院全科医学科,广西柳州545006

出　　处：《山东医药》2022年第27期11-14,共4页Shandong Medical Journal

基　　金：广西壮族自治区卫生健康委员会自筹经费科研项目(Z20190141)。

摘　　要：目的探讨糖化血红蛋白(HbA_(1c))控制达标的急性心肌梗死(AMI)患者发生应激性高血糖(SHG)的危险因素,并构建其风险预测模型。方法HbA_(1c)控制达标的AMI患者433例,其中发生SHG 71例(SHG组)和未发生SHG 362例(非SHG组)。比较两组基线临床资料,包括年龄、性别、吸烟史、高血压病史、糖尿病史、血脂异常史、梗死部位、入院Killip泵功能分级、严重冠脉病变支数、入院心肌钙蛋白Ⅰ(cTnI)、肌酸激酶同工酶(CK-MB)、高敏C反应蛋白(hs-CRP)、白细胞计数(WBC),空腹血糖、HbA_(1c)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)。通过多因素Logistic回归分析HbA_(1c)控制达标的AMI患者发生SHG的危险因素,构建风险预测模型。采用Hosmer-Lemeshow(H-L)检验判断风险预测模型的拟合优度,受试者工作特征曲线(ROC)判断风险预测模型的预测效能。结果与非SHG组比较,SHG组年龄大,糖尿病史患者多,入院Killip泵功能分级≥3级发生率高、空腹血糖高、HbA_(1c)高、WBC计数高(P均<0.05)。年龄[OR=1.028,95%CI(1.006~1.051)]、糖尿病史[OR=5.111,95%CI(1.384~18.867)]、入院Killip泵功能分级≥3级[OR=4.768,95%CI(1.499~15.167)]、WBC计数[OR=1.123,95%CI(1.034~1.219)]是HbA_(1c)控制达标的AMI患者发生SHG的独立危险因素(P均<0.05)。风险预测模型(Logistic回归模型):Logit P=-4.839+0.028×(年龄)+1.631×(糖尿病史)+1.562×(入院Killip泵功能分级≥3级)+0.116×(WBC计数),H-L检验显示本模型拟合优度较高(P=0.351)。风险预测模型预测HbA_(1c)控制达标的AMI患者发生SHG风险的ROC下面积为0.670(95%CI:0.599~0.741,P<0.01),最佳界点为-1.63,敏感度为57.7%,特异度为69.6%,阳性预测值为26.45%,阴性预测值为89.21%。结论年龄、糖尿病史、入院Killip泵功能分级≥3级、WBC计数是AMI患者发生SHG的独立危险因素。基于危险因素建立的风险预测模型预测效度中等,敏�Objective To investigate the risk factors of stress hyperglycemia(SHG)in acute myocardial infarction(AMI)patients whose glycosylated hemoglobin(HbA_(1c))control is up to standard,and to establish the risk prediction model.Methods A total of 433 AMI patients were divided into the SHG group(n=71)and non-SHG group(n=362).Base‐line clinical characteristics including age,gender,smoking history,hypertension history,diabetes mellitus history,hyper‐lipidemia history,infarct site,Killip class at admission,the number of severe coronary artery lesion,cardiac troponin Ⅰ(cTnI),creatine kinase isoenzyme(CK-MB),high-sensitivity C-reactive protein(hs-CRP),white blood cell(WBC)count,fasting blood glucose,HbA_(1c),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density li‐poprotein cholesterol(HDL-C),and triglyceride(TG)were compared.The risk factors for SHG in AMI patients whose HbA_(1c) control was up to standard were analyzed by multivariate Logistic regression analysis,and the risk prediction model was established.Hosmer-Lemeshow(H-L)test was adopted to judge the goodness of fit of the risk prediction model.Re‐ceiver operating characteristic(ROC)curve was adopted to judge the predictive validity of the model.Results The age,history of diabetes,incidence of Killip class≥3,fasting blood glucose,HbA_(1c) and WBC count in the SHG group were higher than those in the non-SHG group(all P<0.05).Age[OR=1.028,95%CI(1.006,1.051)],diabetes melli‐tus history[OR=5.111,95%CI(1.384,18.867)],Killip class≥3 at admission[OR=4.768,95%CI(1.499,15.167)],and WBC count[OR=1.123,95%CI(1.034,1.219)]were independent risk factors for SHG in AMI patients whose HbA_(1c) control was up to standard(all P<0.05).The established Logistic regression model was:Logit P=-4.839+0.028(age)+1.631(history of diabetes)+1.562(Killip class≥3)+0.116(WBC count).H-L test showed significant goodness of fit of the model(P=0.351).The area under ROC curve was 0.670(95%CI:0.599-0.741,P<0.01),suggesting moder‐ate predictive effect of the m

关 键 词：心肌梗死并发症 应激性高血糖 急性心肌梗死 

分 类 号：R540.4[医药卫生—心血管疾病]