预后营养指数与急性ST段抬高型心肌梗死合并2型糖尿病患者经皮冠状动脉介入术后院内主要不良心血管事件关系的研究  

Relationship between Prognostic Nutritional Index and Major In-hospital Adverse Cardiovascular Events after Percutaneous Coronary Intervention in Patients with Acute ST-elevation Myocardial Infarction Complicated by Type 2 Diabetes Mellitus

作　　者：赵帮豪 袁腾 赵翎 阿曼古丽·如则 尼鲁帕尔·谢甫开提 马依彤[1] 杨毅宁[1,3] 高晓明 ZHAO Banghao;YUAN Teng;ZHAO Ling;AMANGULI Ruze;NILUPAER Xiefukaiti;MA Yitong;YANG Yining;GAO Xiaoming(Department of Cardiology,the First Affiliated Hospital/State Key Laboratory of Pathogenesis/Prevention and Treatment of High Incidence Diseases in Central Asia/Clinical Medical Research Institute,Xinjiang Medical University,Urumqi 830054,China;Xinjiang Key Laboratory of Medical Animal Model Research,Urumqi 830054,China;People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]省部共建中亚高发病成因与防治国家重点实验室,新疆医科大学第一附属医院心内科,新疆医科大学临床医学研究院,新疆维吾尔自治区乌鲁木齐市830054 [2]新疆医学动物模型研究重点实验室,新疆维吾尔自治区乌鲁木齐市830054 [3]新疆维吾尔自治区人民医院,新疆维吾尔自治区乌鲁木齐市830001

出　　处：《中国全科医学》2024年第15期1817-1824,共8页Chinese General Practice

基　　金：新疆重点实验室开放课题项目(2021D04020,2020D04027);省部共建中亚高发病成因与防治国家重点实验室开放课题项目(SKL-HIDCA-2021-XXG1,SKL-HIDCA-2022-XXG1)。

摘　　要：背景 近年来我国糖尿病和心血管疾病患病人数逐年增加,已有研究证明了糖尿病可扩大心血管疾病的不良影响,涉及营养和炎症途径。预后营养指数(PNI)是免疫营养的标志,可反映个体的炎症、免疫状态和营养状况。由于其简单、快速、易得和可靠等优点,近年来关于PNI在各系统中的研究越来越多,但少有文献探讨PNI在心血管疾病中的作用。目的 本研究旨在探讨PNI与急性ST段抬高型心肌梗死(STEMI)合并2型糖尿病(T2DM)患者经皮冠状动脉介入(PCI)术后发生院内主要不良心血管事件(MACE)的关系。方法 回顾性分析2015年1月—2023年6月在新疆医科大学第一附属医院1 053例行PCI术的STEMI合并T2DM患者的临床资料。收集患者资料,计算PNI,根据患者住院期间是否发生MACE,分为MACE组(177例)和非MACE组(876例)。同时依据PNI预测STEMI合并T2DM患者行PCI术后发生院内MACE的截断值将患者分为高PNI组(686例)与低PNI组(367例)。采用单因素及多因素Logistic回归分析探究STEMI合并T2DM患者行PCI后发生院内MACE的影响因素。绘制受试者工作特征(ROC)曲线探究PNI对STEMI合并T2DM患者行PCI术后发生院内MACE的预测价值,计算曲线下面积(AUC)。采用Pearson相关性分析或Spearman秩相关分析探究PNI与心血管疾病危险因素之间的相关性。结果MACE组和非MACE组性别、年龄、高血压病史、血清葡萄糖、Killip分级、乳酸脱氢酶、心率、肌红蛋白、肌酸激酶-MB同工酶(CK-MB)、白细胞计数、脑钠肽(BNP)、PNI、全球急性冠脉事件注册(GRACE)评分、血红蛋白、血小板计数、淋巴细胞计数、白蛋白、总蛋白、肌酐、尿素氮、三酰甘油比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,血清葡萄糖升高(OR=1.055,95%CI=1.002~1.112,P=0.044)、GRACE评分高(OR=1.034,95%CI=0.876~0.939,P<0.001)是STEMI合并T2DM患者行PCI术后发生院内MACE的危险因素,PNI升Background The prevalence of diabetes and cardiovascular diseases in China has been increasing annually,and it has been demonstrated that diabetes can exacerbate the adverse effects of cardiovascular diseases through nutritional and inflammatory pathways.The prognostic nutritional index(PNI)is a marker of immunonutrition that reflects the inflammation,immune status and nutritional status of an individual.Due to its advantages of simplicity,rapidity,accessibility,and reliability,research on PNI has been increasing,yet its role in cardiovascular diseases has been less explored.Objective To investigate the relationship between PNI and major in-hospital adverse cardiovascular events(MACE)in patients with acute ST-elevation myocardial infarction(STEMI)complicated by type 2 diabetes mellitus(T2DM)following percutaneous coronary intervention(PCI).Methods A retrospective analysis of 1053 STEMI patients with T2DM who underwent PCI at the First Affiliated Hospital of Xinjiang Medical University from January 2015 to June 2023 was conducted.The patients were divided into the MACE(n=177)and non-MACE(n=876)groups according to the occurrence of MACE during hospitalization,and further categorized into the high PNI(n=686)and low PNI(n=367)groups according based on the cutoff value of PNI to predict the occurrence of in-hospital MACE after PCI in patients with STEMI and T2DM.Univariate and multivariate Logistic regression analyses identified factors influencing in-hospital MACE after PCI in patients with STEMI and T2DM.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive value of PNI for in-hospital MACE,and the area under the curve(AUC)was calculated.Pearson correlation analysis or Spearman rank correlation analysis was used to explore the correlation between PNI and cardiovascular disease risk factors.Results The differences between the MACE and non-MACE groups in gender,age,history of hypertension,serum glucose,Killip classification,lactate dehydrogenase,heart rate,myoglobin,creatine kinase-MB is

关 键 词：ST段抬高型心肌梗死 糖尿病 2型 主要不良心血管事件 预后营养指数 预测价值 

分 类 号：R542.22[医药卫生—心血管疾病]