非糖尿病急性心肌梗死患者应激性高血糖的危险因素分析及LDL⁃C/HDL⁃C比值的预测效能  

Risk factors of stress hyperglycemia in non⁃diabetic patients with acute myocardial infarction and predictive efficacy of LDL⁃C/HDL⁃C ratio

作　　者：梁伟霄 郭凤娟 陈要起 杨晔娟 刘雨 LIANG Weixiao;GUO Fengjuan;CHEN Yaoqi;YANG Yejuan;LIU Yu(Department of Cardiology,Xingtai Central Hospital,Xingtai,Hebei,China,054000)

机构地区：[1]邢台市中心医院心内科,河北邢台054000

出　　处：《分子诊断与治疗杂志》2025年第1期50-53,共4页Journal of Molecular Diagnostics and Therapy

基　　金：河北省医学科学研究课题计划项目(20191676);邢台市科学技术项目(2020ZC305)。

摘　　要：目的探讨非糖尿病急性心肌梗死(AMI)患者应激性高血糖(SHG)的危险因素及低密度脂蛋白胆固醇/高密度脂蛋白胆固醇(LDL⁃C/HDL⁃C)比值的预测效能。方法选取2021年10月至2023年10月邢台市中心医院收治的126例非糖尿病AMI患者作为研究对象,根据是否发生SHG分为SHG组(n=32)、非SHG组(n=94)。检测两组LDL⁃C、HDL⁃C水平,并计算这两项指标的比值;采用二分类Logistic逐步回归分析探讨非糖尿病AMI患者SHG的影响因素;采用受试者工作特性(ROC)曲线评估LDL⁃C/HDL⁃C比值对非糖尿病AMI患者SHG的预测价值。结果SHG组年龄≥60岁所占比例、Killip心功能分级≥Ⅲ级所占比例、空腹血糖(FBG)、LDL⁃C、心肌肌钙蛋白I(cTnI)、N末端⁃B型脑钠肽(Nt⁃proBNP)水平均高于非SHG组,HDL⁃C、左心室射血分数(LVEF)水平低于非SHG组,差异有统计学意义(P<0.05)。年龄≥60岁、Killip心功能分级≥Ⅲ级、LDL⁃C水平高、Nt⁃proBNP水平高是非糖尿病AMI患者SHG的独立危险因素(P<0.05)。LDL⁃C/HDL⁃C比值预测非糖尿病AMI患者SHG的曲线下面积(AUC)(95%CI)为0.857(0.805~0.909),截点值为3.23,特异度为0.659,灵敏度为0.915。高LDL⁃C/HDL⁃C比值组SHG发生率高于低LDL⁃C/HDL⁃C比值组,差异有统计学意义(P<0.05)。结论非糖尿病AMI患者SHG的发生受到年龄、Killip心功能分级等多种因素的影响;LDL⁃C/HDL⁃C比值与非糖尿病AMI患者SHG密切相关,可作为潜在的预测标记物。Objective To explore the risk factors of stress hyperglycemia(SHG)in non⁃diabetic cases with acute myocardial infarction(AMI)and the predictive efficacy of low⁃density lipoprotein cholesterol/high density lipoprotein cholesterol(LDL⁃C/HDL⁃C)ratio.Methods 126 non⁃diabetic AMI cases from October 2021 to October 2023 were selected and divided into two groups:the SHG group(n=32)and the non⁃SHG group(n=94)based on the occurrence of SHG.Levels of LDL⁃C and HDL⁃C were measured using an automatic biochemical analyzer,and the ratio of these two indicators was calculated.Factors influencing SHG in the non⁃diabetic patients with AMI were explored through binary logistic stepwise regression analysis.The predictive value of the LDL⁃C/HDL⁃C ratio for SHG in the non⁃diabetic cases with AMI was evaluated using ROC analysis.Results The proportion of individuals aged≥60 years old in the SHG group,as well as the proportion of those with Killip cardiac function grade≥Ⅲ,fasting blood glucose(FBG),LDL⁃C,cardiac troponin I(cTnI),and N⁃terminal B⁃type brain natriuretic peptide(Nt⁃proBNP)levels,were higher than those in the non⁃SHG group(P<0.05).Conversely,the levels of HDL⁃C and left ventricular ejection fraction(LVEF)were lower in the SHG group compared to the non⁃SHG group(P<0.05).Factors such as age≥60 years old,Killip cardiac function grade≥Ⅲ,high LDL⁃C level and high Nt⁃proBNP level were identified as independent risk factors for SHG in the non⁃diabetic AMI cases(P<0.05).The LDL⁃C/HDL⁃C ratio was found to predict the area under the curve(AUC)(95%CI)of SHG in non⁃diabetic AMI cases to be 0.857(0.805⁃0.909),with a cut⁃off point of 3.23,a specificity of 0.659,and a sensitivity of 0.915.The incidence of SHG was significant higher in the in high LDL⁃C/HDL⁃C ratio group compared to the low LDL⁃C/HDL⁃C ratio group(P<0.05).Conclusion The incidence of SHG in non⁃diabetic AMI patients is influenced by age,Killip cardiac function grade,and other factors.The LDL⁃C/HD

关 键 词：急性心肌梗死 应激性高血糖 危险因素 LDL⁃C/HDL⁃C比值 

分 类 号：R542.22[医药卫生—心血管疾病]