慢性心力衰竭患者三酰甘油葡萄糖指数与心房颤动发生的相关性研究  

Correlation between Triglyceride Glucose Index and Atrial Fibrillation in Patients with Chronic Heart Failure

作　　者：白璐 张强[1] 刘方方 孙彩红[1] 费思杰 信彩凤 BAI Lu;ZHANG Qiang;LIU Fangfang;SUN Caihong;FEI Sijie;XIN Caifeng(Vasculocardiology Deparment,the Second Affliated Hospital of Zhengzhou University,Zhengzhou 451100,China)

机构地区：[1]郑州大学第二附属医院心血管内科,河南省郑州市451100

出　　处：《中国全科医学》2025年第6期720-728,共9页Chinese General Practice

基　　金：河南省医学科研攻关计划项目(LHGJ20220442)。

摘　　要：背景胰岛素抵抗(IR)与心房颤动(AF)及心房重构有关,三酰甘油葡萄糖(TyG)指数作为IR新型简单且有价值的指标与慢性心力衰竭(CHF)患者发生AF相关性的研究甚少。目的探讨CHF患者TyG指数与AF发生风险的相关性。方法回顾性选取2021年1月—2022年1月在郑州大学第二附属医院心血管内科住院的CHF患者417例为研究对象,根据CHF患者是否发生AF将其分为两组:AF组(138例)和非AF组(279例)。依据四分位数将TyG指数分为4个水平:Q1(TyG指数≤8.20)、Q2(8.20<TyG指数≤8.44)、Q3(8.44<TyG指数≤8.84)、Q4(TyG指数>8.84)。通过医院电子病历系统收集患者基线资料,包括TyG指数及基本资料、实验室检查指标、超声心动图资料等。利用LASSO回归分析进行变量筛选,采用多因素Logistic回归分析探讨CHF患者TyG指数与AF发生风险的相关性,并构建回归模型。同时采用受试者工作特征曲线分析TyG指数对CHF患者发生AF的预测价值。绘制TyG指数与CHF患者AF发生风险相关性的限制性立方样条图。结果AF组患者BMI,美国纽约心脏病学会心功能分级Ⅲ~Ⅳ级、高血压比例,血尿酸(SUA)、三酰甘油、血尿素氮(BUN)、空腹血糖、N末端B型钠尿肽前体、TyG指数、左心房内径(LAD),β受体阻滞剂、钙拮抗剂、利尿剂使用比例高于非AF组,而总胆固醇(TC)、内生肌酐清除率(Ccr)、左心室射血分数,血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)类药物使用比例低于非AF组(P<0.05)。多因素Logistic回归分析结果显示,合并高血压(OR=1.749,95%CI=1.048~2.918,P=0.032)、BUN升高(OR=1.269,95%CI=1.104~1.457,P=0.001)、SUA升高(OR=1.002,95%CI=1.000~1.005,P=0.047)、TyG指数升高(OR=2.360,95%CI=1.397~3.987,P=0.001)、LAD升高(OR=1.065,95%CI=1.034~1.097,P<0.001)、使用利尿剂(OR=4.019,95%CI=2.140~7.548,P<0.001)是CHF患者发生AF的危险因素;Ccr升高(OR=0.985,95%CI=0.975~0.996,P=0.006)、TC升高(OR=0.587,95%CI=0.445~0.7Background Insulin resistance(IR)is associated with atrial fibrillation(AF)and atrial remodeling,and the correlation of triacylglycerol glucose(TyG)index,a novel,simple,and valuable indicator of IR,with the development of AF in patients with chronic heart failure(CHF)has been poorly studied.Objective To investigate the correlation between TyG index and AF in patients with CHF.Methods A total of 417 CHF patients hospitalized in the Department of Cardiovascular Medicine of the Second Affiliated Hospital of Zhengzhou University from January 2021 to January 2022 were retrospectively selected for the study,and the CHF patients were divided into two groups according to whether they developed AF:the AF group(138 patients)and the non-AF group(279 patients).The TyG index was categorized into four levels based on quartiles:Q1(TyG index≤8.20),Q2(8.20<TyG index≤8.44),Q3(8.44<TyG index≤8.84),and Q4(TyG index>8.84).Patients'baseline data,including TyG index and basic information,laboratory test indexes,and echocardiographic data,were collected through the hospital's electronic medical record system.The LASSO regression algorithm was used for variable screening,and multivariate Logistic regression was used to analyze the correlation between TyG index and the risk of AF occurrence in patients with CHF and to construct a regression model.The predictive value of TyG index for the occurrence of AF in CHF patients was also analyzed using the subject work characteristics curve.Restricted cubic spline plots of the correlation between TyG index and the risk of developing AF in CHF patients were plotted.Results Patients in the AF group had higher BMI,New York Heart Association cardiac function classⅢ-Ⅳ,proportion of hypertension,serum uric acid(SUA),triacylglycerol,blood urea nitrogen(BUN),fasting blood glucose,N-terminal B-type natriuretic peptide precursor,TyG index,left atrial diameter(LAD),the proportions ofβ-blockers,calcium antagonists,and diuretics were higher than those in the non-AF group;total cholesterol(TC),endoge

关 键 词：心力衰竭 心房颤动 慢性心力衰竭 三酰甘油葡萄糖指数 胰岛素抵抗 LASSO回归 

分 类 号：R541[医药卫生—心血管疾病]