行直接PCI的急性心肌梗死患者TYG与缺血事件的相关性分析  

Correlation between TYG and ischemic events in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

作　　者：周鹤[1,2] 裘淼涵 那堃 范鹏 祁子钊 李毅 韩雅玲 Zhou He;Qiu Miao-Han;Na Kun;Fan Peng;Qi Zi-Zhao;Li Yi;Han Ya-Ling(Graduate School of Liaoning University of Traditional Chinese Medicine,Shenyang,Liaoning 110032,China;Department of Cardiology,General Hospital of Northern Theater Command,Shenyang,Liaoning 110016,China)

机构地区：[1]辽宁中医药大学研究生院,辽宁沈阳110032 [2]北部战区总医院心血管内科,辽宁沈阳110016

出　　处：《解放军医学杂志》2023年第8期944-949,共6页Medical Journal of Chinese People's Liberation Army

基　　金：中国医师协会“立信扬帆”优化抗栓科研基金(BJUHFCSOARF201801-04);沈阳市科学技术计划(21-173-9-66)。

摘　　要：目的探讨急诊行直接经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者入院时三酰甘油-葡萄糖指数(TYG)与1年主要缺血事件的相关性。方法本研究为单中心注册登记数据库的回顾性分析。收集2016年3月-2019年3月在北部战区总医院心血管内科诊断为AMI并行急诊PCI的2203例患者的临床资料,根据入院时TYG将患者分为TYG<9.1047组(n=1101)和TYG≥9.1047组(n=1102),分析比较两组患者的人口学特征、危险因素及并发症、实验室检查结果、手术特征、出院后用药情况,以及出院后1年内缺血事件[定义为心源性死亡、心肌梗死和(或)缺血性卒中]和全因死亡事件的发生情况,并采用Cox回归风险比例模型分析TYG与主要结局指标的相关性,采用受试者工作特征(ROC)曲线评价TYG对1年缺血事件的预测价值。结果与TYG<9.1047组比较,TYG≥9.1047组患者的年龄偏小,男性比例较低,合并高血压、糖尿病的比例较高(P<0.05)。与TYG<9.1047组比较,TYG≥9.1047组出院后1年内的缺血事件、心源性死亡和全因死亡的发生率较高,差异有统计学意义(P<0.05)。ROC曲线分析显示,TYG对行急诊PCI的AMI患者出院后1年缺血事件和全因死亡具有良好的预测价值,曲线下面积(AUC)分别为0.62(95%CI 0.55~0.68)和0.61(95%CI 0.55~0.68),区分主要终点1年缺血事件的最佳切点为9.5948,敏感度为47.3%,特异度为76.5%。结论AMI患者入院时TYG过高与急诊PCI术后1年内缺血事件的增多明显相关。Objective To discuss the correlation between triglyceride-glucose index(TYG)and the major ischemic events in the past year in patients with acute myocardial infarction(AMI)treated with primary percutaneous coronary interventions(PCI).Methods The present study is a retrospective analysis based on a single-center registration database.From March 2016 to March 2019,the clinical data of 2203 eligible patients with AMI undergoing primary PCI were collected from the General Hospital of Northern Theater Command,and divided into two groups according to the median TYG index at admission[TYG<9.1047 group(n=1101)and TYG≥9.1047 group(n=1102)].The demographic characteristics,risk factors and complication,laboratory test,operation characteristics and medication after discharge were compared between the two groups.Meanwhile,the one-year ischemic events(cardiac death,myocardial infarction and/or ischemic stroke)and all-cause death were compared between the two groups.The Cox regression models were used to analyze the correlation between TYG and main outcomes.To evaluate the predictive value of TYG for one-year ischemic events using the ROC curve.Results Compared with TYG<9.1047 group,patients in TYG≥9.1047 group were younger,less male,and had a higher proportion of hypertension and diabetes(P<0.05),and higher incidence with significant differences(P<0.05)in the frequency of one-year ischemic events,cardiac death and all-cause death.The TYG showed acceptable performance in prediction of one-year ischemic events and all-cause death with areas under the curve(AUC)of 0.62(95%CI 0.55-0.68)for ischemic events and 0.61(95%CI 0.55-0.68)for all-cause death.The best cut-off point for distinguishing the main end point from one-year ischemic events was 9.5948,the sensitivity was 47.3%,and the specificity was 76.5%.Conclusion Excessive TYG at admission of AMI patients is significantly related to the incidence of one-year ischemic events after PCI.

关 键 词：急性心肌梗死 冠状动脉介入治疗 缺血事件 三酰甘油-葡糖糖指数 

分 类 号：R541.4[医药卫生—心血管疾病]