系统性免疫炎症指数对冠心病合并糖尿病老年患者发生心肌梗死事件的影响  

Effect of systemic immune index on myocardial infarction events in elderly patients with coronary heart disease and type 2 diabetes mellitus

作　　者：王聪颖 陈坤 王立立[1] 陈淑霞[1] 谷剑[1] Wang Congying;Chen Kun;Wang Lili;Chen Shuxia;Gu Jian(Department of Cardiovascular Diseases,Hebei General Hospital,Shijiazhuang 050051,Hebei Province,China)

机构地区：[1]河北省人民医院心血管内科,石家庄050051

出　　处：《中华老年心脑血管病杂志》2025年第3期280-284,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：河北省医学科学研究计划项目(20200712)。

摘　　要：目的探讨系统性免疫炎症指数(systemic immune-inflammation index,SII)与冠心病合并2型糖尿病老年患者短期发生心肌梗死事件的关系。方法选取2022年1月至2023年1月于河北省人民医院心血管内科住院治疗的冠心病合并2型糖尿病患者382例,根据1年内是否发生心肌梗死分为心肌梗死组83例和非心肌梗死组299例。比较2组一般临床资料,采用多因素logistic回归分析发生心肌梗死事件的危险因素,采用ROC曲线分析SII、空腹血糖(fasting plasma glucose,FPG)及二者联合预测对1年内发生心肌梗死事件的预测价值,采用Kaplan-Meier生存曲线分析SII与发生心肌梗死事件的关系。结果多因素logistic回归分析显示,SII、FPG、外周动脉粥样硬化是发生心肌梗死事件的危险因素(OR=1.001,95%CI:1.000~1.001,P=0.001;OR=1.106,95%CI:1.016~1.203,P=0.020;OR=4.798,95%CI:2.621~8.786,P=0.000),胰高血糖素样肽1受体激动剂和钠-葡萄糖协同转运蛋白2抑制剂是发生心肌梗死事件的保护因素(OR=0.255,95%CI:0.073~0.895,P=0.033;OR=0.474,95%CI:0.270~0.834,P=0.010)。ROC曲线分析显示,SII、FPG及二者联合预测冠心病合并2型糖尿病患者1年内发生心肌梗死事件的曲线下面积分别为0.675、0.619、0.702,二者联合预测优于单独预测(P<0.01)。Kaplan-Meier曲线分析显示,高水平患者累计生存率显著低于低水平患者(Plog rank<0.01)。结论在冠心病合并2型糖尿病的老年患者中,SII、FPG、外周动脉粥样硬化是发生心肌梗死事件的独立危险因素,SII和FPG对心肌梗死的发生有一定预测价值。Objective To investigate the correlation of SII with occurrence of short-term MI in elderly patients with CHD complicated with T2DM.Methods A total of 382 CHD patients with concomitant T2DM admitted in our hospital from January 2022 to January 2023 were enrolled,and according to occurrence of MI within 1 year,they were divided into a MI group(83 patients)and a non-MI group(299 patients).Clinical data were collected,and multivariate logistic regression analysis was used to determine the risk factors for MI in the patients.ROC curve was plotted to evaluate the predictive value of SII,fasting blood glucose(FPG)and their combination for 1-year MI occurrence.Kaplan-Meier curve was drawn to analyze the relationship between SII and MI.Results Multivariate logistic regression analysis showed that SII,FPG and peripheral atherosclerosis were risk factors for MI occurrence(OR=1.001,95%CI:1.000-1.001,P=0.001;OR=1.106,95%CI:1.016-1.203,P=0.020;OR=4.798,95%CI:2.621—8.786,P=0.000),and GLP-1RA and SGLT2i were protective factors for the occurrence(OR=0.255,95%CI:0.073-0.895,P=0.033;OR=0.474,95%CI:0.270-0.834,P=0.010).ROC curve analysis indicated showed that the AUC value of SII,FPG and their combination was 0.675,0.619 and 0.702,respectively,and the predictive performance was better in the combination than the indicator alone(P<0.01).Kaplan-Meier curve analysis revealed that the cumulative survival rate in the highlevel group was significantly lower than that in the low-level group(Piog rank<0.01).Conclusion For the elderly T2DM patients with concomitant CHD,SII,FPG and atherosclerosis are independent risk factors for MI occurrence.SII and FPG have certain predictive value for the occurrence.

关 键 词：冠心病 糖尿病 心肌梗死 回归分析 动脉粥样硬化 危险因素 

分 类 号：R542.22[医药卫生—心血管疾病] R541.4[医药卫生—内科学] R587.1[医药卫生—临床医学]