控制营养状况评分与ST段抬高型心肌梗死合并2型糖尿病患者预后的相关性研究  

Controlling nutritional status score predicts adverse cardiovascular events in st-elevated myocardial infarction patients with type 2 diabetes

作　　者：任萍安 徐娇艳 陈静静 陈荣敏[1] 施国富[1] REN Pingan;XU Jiaoyan;CHEN Jingjing;CHEN Rongmin;SHI Guofu(Department of Cardiovascular,The Third People's Hospital of Yancheng,Yancheng 22400,China)

机构地区：[1]盐城市第三人民医院心血管内科,224000

出　　处：《心肺血管病杂志》2024年第10期1045-1051,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：盐城市医学科技发展计划项目(YK2019096)。

摘　　要：目的:探索控制营养状况(controlling nutritional status,CONUT)与ST段抬高型心肌梗死(ST-elevated myocardial infarction,STEMI)合并2型糖尿病患者主要心血管事件(major adverse cardiovascular events,MACE)发生风险的相关性。方法:本研究为回顾性队列研究,共纳入508例STEMI合并2型糖尿病患者。根据CONUT评分将患者分为四种营养状态:正常(0~1分)、轻度(2~4分)、中度(5~8分)和重度(9~12分)。Cox回归模型用于分析CONUT评分与MACE的相关性。绘制Kaplan-Meier曲线比较各组MACE的累积发生率。限制性样条(restricted cubic spline,RCS)曲线用于评估CONUT评分与MACE风险的剂量-反应关系。结果:随访期间共125例(24.6%)患者发生MACE。多因素Cox回归分析显示,中度营养不良组(HR=2.48,95%CI:1.11~5.54,P=0.027)和重度营养不良组(HR=3.23,95%CI:1.31~7.94,P=0.011)MACE风险显著升高。Kaplan-Meier曲线显示,较高CONUT评分的患者MACE累积发生率显著升高(Log-rank P=0.001)。RCS曲线提示,CONUT评分与MACE风险呈正相关。亚组分析显示,相较与非肥胖组,肥胖组中CONUT评分对于MACE风险的预测能力更为显著,存在显著交互作用(P=0.046)。结论:在STEMI合并2型糖尿病患者中,高CONUT评分与MACE风险增加独立相关,尤其在肥胖人群中更为显著。Objective:To explore the association between the controlling nutritional status(CONUT)score and the risk of major adverse cardiovascular events(MACE)in patients with ST-segment elevation myocardial infarction(STEMI)and type 2 diabetes mellitus(T2DM).Methods:This retrospective cohort study included 508 STEMI patients with T2DM.Patients were classified into four nutritional status groups based on their CONUT scores:Normal(0-1),mild(2-4),moderate(5-8),and severe(9-12).Cox regression models were used to analyze the association between CONUT scores and MACE.Kaplan-Meier curves were plotted to compare the cumulative incidence of MACE among the groups.Restricted cubic spline(RCS)curves were used to assess the dose-response relationship between CONUT scores and MACE risk.Results:During follow-up,125(24.6%)patients experienced MACE.Multivariate Cox regression analysis showed that the risk of MACE was significantly higher in the moderate(HR=2.48,95%CI:1.11-5.54,P=0.027)and severe malnutrition groups(HR=3.23,95%CI:1.31-7.94,P=0.011).Kaplan-Meier curves demonstrated that patients with higher CONUT scores had a significantly higher cumulative incidence of MACE(Log-rank P=0.001).RCS curves suggested a positive correlation between CONUT scores and MACE risk.Subgroup analysis revealed that the predictive ability of CONUT scores for MACE risk was more significant in the obese group compared to the non-obese group,with a significant interaction(P=0.046).Conclusion:In STEMI patients with T2DM,high CONUT scores are independently associated with an increased risk of MACE,particularly in the obese population.

关 键 词：ST段抬高型心肌梗死 2型糖尿病 控制营养状况评分 主要不良心血管事件 营养状态 

分 类 号：R54[医药卫生—心血管疾病]