冠心病PCI术后血瘀证患者甘油三酯葡萄糖乘积指数与主要心血管不良事件风险的相关性  

Association between Triglyceride-Glucose Index and Major Adverse Cardiovascular Events Risk in Coronary Heart Disease Patients with Blood Stasis Syndrome after Percutaneous Coronary Intervention

作　　者：陶诗怡 于林童 李军[2] 黄力[3] 解紫从 杨德爽 薛甜甜 谭雨晴 TAO Shiyi;YU Lintong;LI Jun;HUANG Li;XIE Zicong;YANG Deshuang;XUE Tiantian;TAN Yuqing(Beijing University of Chinese Medicine,Beijing,100029;Guang'anmen Hospital,China Academy of Chinese Medical Sciences;China-Japan Friendship Hospital)

机构地区：[1]北京中医药大学,北京市朝阳区100029 [2]中国中医科学院广安门医院 [3]中日友好医院

出　　处：《中医杂志》2024年第17期1784-1793,共10页Journal of Traditional Chinese Medicine

基　　金：中央高水平中医医院临床科研业务费(HLCMHPP2023065);国家重点研发计划(2019YFC1708602,2022YFC3500102)。

摘　　要：目的 探讨冠心病经皮冠状动脉介入术(PCI)后血瘀证患者甘油三酯葡萄糖乘积(TyG)指数与主要心血管不良事件(MACEs)风险的相关性。方法 纳入冠心病PCI术后血瘀证患者857例,依据基线TyG指数四分位数分为Q1 (TyG<8.51)、Q2 (8.51≤TyG<8.88)、Q3 (8.88≤TyG<9.22)、Q4 (TyG≥9.22)四组。临床结局指标为MACEs,包括心源性死亡、非致死性心肌梗死、非计划性血运重建、支架内再狭窄、脑卒中。通过机器学习Boruta算法进行MACEs风险相关特征变量选择。利用Kaplan-Meier生存分析和Cox比例风险回归模型分析比较各组间MACEs风险差异。采用限制性立方样条(RCS)和亚组分析探讨TyG指数和MACEs风险的关系。通过受试者工作特征(ROC)曲线下面积(AUC)、校准曲线、HosmerLemeshow检验及决策曲线分析(DCA)评价TyG指数对MACEs风险的临床预测效能。结果 纳入患者中位随访时间为2.45年,新发MACEs患者313例(36.52%)。Q1组、Q2组、Q3组、Q4组的发病率分别为28.17%(60例/213例)、29.05%(61例/210例)、39.45%(86例/218例)、49.07%(106例/216例)。KaplanMeier生存分析表明,各组间MACEs风险比较差异有统计学意义(P<0.001)。Cox比例风险回归模型分析表明,高TyG指数的MACEs风险升高了60.1%(P<0.01)。以Q1组为参照,Q2组、Q3组和Q4组的MACEs风险随着TyG指数增加逐渐升高,趋势变化具有统计学意义(P<0.05)。RCS分析表明,TyG指数与MACEs风险呈非线性相关(P<0.001)。ROC曲线分析[AUC 0.758 (0.724~0.792)]和Hosmer-Lemeshow检验结果(χ^(2)=4.319,P=0.827)提示,TyG指数对MACEs风险的临床预测效能较高;DCA分析表明TyG指数有较好的临床有效性。亚组分析显示,在年龄、男性、体重指数(BMI)、糖尿病史是或否、有高血压病史、低密度脂蛋白胆固醇(LDL-C)≥1.8 mmol/L各亚组中,均表明高TyG指数与MACEs风险呈正相关(P<0.05)。结论 冠心病PCI术后血瘀证患者的高TyG指数与MACEs的发生密切相关,对患者早Objective To explore the association between triglyceride-glucose(TyG)index and major adverse cardiovascular events(MACEs)risk in coronary heart disease(CHD)patients with blood stasis syndrome after percutaneous coronary intervention(PCI).Methods A total of 857 CHD patients with blood stasis syndrome after PCI were enrolled and divided into four groups according to the baseline TyG index quartiles,Q1(TyG<8.51),Q2(8.51≤TyG<8.88),Q3(8.88≤TyG<9.22),and Q4(TyG≥9.22).The clinical outcome was defined as a compound endpoint of cardiovascular events including cardiac death,non-fatal myocardial infarction,unplanned revascularization,in-stent restenosis and stroke.The machine learning Boruta algorithm was used for feature selection related to MACEs risk.Kaplan-Meier survival analysis and Cox proportional hazards regression model were used to compare the dfferences in MACEs risk among the four groups.Restricted cubic spline(RCS)and subgroup analysis were performed to determine the relationship between the TyG index and MACEs risk.The area under the receiver operating characteristic(ROC)curve(AUC),calibration curve and Hosmer-Lemeshow test,and decision curve analysis(DCA)were plotted to evaluate the predictive value of the TyG index for MACEs risk.Results The median followup time of the included patients was 2.45 years.During the follow-up period,313 cases(36.52%)of new MACEs occurred.The incidence of MACEs in Q1,Q2,Q3,Q4 group was 28.17%(60/213),29.05%(61/210),39.45%(86/218)and 49.07%(106/216),respectively.Kaplan-Meier survival analysis suggested statistically significant differences in MACEs risk among the four groups(P<0.001).Cox proportional hazards regression model analysis found that the risk of MACEs in patients with high TyG index increased by 60.1%(P<0.01).Using Q1 as the reference,the MACEs risk in Q2,Q3 and Q4 groups gradually increased,and the trend was statistically significant(P<0.05).RCS model suggested that the TyG index was nonlinearly associated with the MACEs risk(P<0.001).The TyG index had a good pr

关 键 词：冠心病 经皮冠状动脉介入术 血瘀证 甘油三酯葡萄糖乘积指数 主要心血管不良事件 

分 类 号：R541.4[医药卫生—心血管疾病]