基于TyG指数的临床列线图预测ACS合并T2DM患者PCI术后1年内发生MACE的研究  

A clinical nomogram based on triglyceride-glucose index for predicting major adverse cardiovascular events in patients with acute coronary syndrome complicated by type 2 diabetes mellitus after PCI

作　　者：金靖昆 丁家辉 朱英华 仇航 王琳升 张旭东 彭旌峰 李文华 Jin Jingkun;Ding Jiahui;Zhu Yinghua;Qiu Hang;Wang Linsheng;Zhang Xudong;Peng Jingfeng;Li Wenhua(Graduate School,Xuzhou Medical University,Xuzhou 221004,China.;不详)

机构地区：[1]徐州医科大学研究生院,徐州221004 [2]徐州医科大学附属医院心内科,徐州221004

出　　处：《中国循证心血管医学杂志》2025年第2期226-231,236,共7页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的构建一个预测急性冠脉综合征(ACS)合并2型糖尿病(T2DM)患者在经皮冠状动脉介入治疗(PCI)术后1年内发生主要不良心血管事件(MACE)的风险预测模型,并评价其有效性。方法分析2019年1月至2021年12月于徐州医科大学附属医院接受PCI的468例ACS合并T2DM患者的临床资料。根据其甘油三酯-葡萄糖(TyG)指数值被分为三个不同的组,即低TyG指数组(TyG指数≤8.77,n=156)、中TyG指数组(TyG指数为8.77~9.47,n=156)和高TyG指数组(TyG指数≥9.47,n=156)。随访并评估1年内各组MACE的发生情况。使用Kaplan-Meier(K-M)分析比较三组之间的生存差异。基于确定的风险因素或临床特征构建列线图,使用一致性指数来确定其预测的准确性。结果468例患者中148例(31.6%)出现MACE。经LASSO回归和单因素、多因素Cox分析筛选,年龄、吸烟、低密度脂蛋白胆固醇(LDL-C)、尿素和TyG指数被确定为T2DM患者ACS经PCI术后MACE的独立预测因子,其中根据TyG指数分组的K-M分析显示,随着TyG指数提高,MACE发生率显著升高。计算上述各个影响因素对结局变量的影响程度并评分,将各个评分相加得到总评分,在训练集和验证集得到风险得分。训练集和验证集的AUC值分别为0.729(95%CI:0.671~0.788)和0.745(95%CI:0.654~0.836),表明该列线图的预测具有较高的准确性。结论患有ACS合并T2DM患者在PCI术后,如TyG指数水平较高,则MACE发生的风险增加。根据确定的变量构建的列线图对ACS合并T2DM患者PCI术后的MACE发生结果具有一定预测价值,值得临床应用。Objective To establish a risk predictive model for forecasting major adverse cardiovascular events(MACE)in patients with acute coronary syndrome(ACS)complicated by type 2 diabetes mellitus(T2DM)within 1 y after percutaneous coronary intervention(PCI),and review validity of the model.Methods The clinical materials were analyzed in patients with ACS complicated by T2DM undergone PCI(n=468)in Affiliated Hospital of Xuzhou Medical University from Jan.2019 to Dec.2021.All patients were divided,according to value of triglyceride-glucose index(TyG),into low-TyG group(TyG≤8.77,n=156),mid-TyG group(TyG=8.77~9.47,n=156)and high-TyG group(TyG≥9.47,n=156).The occurrence of MACE was reviewed in 3 groups within 1-y follow-up.The difference in survival was compared by using Kaplan-Meier(K-M)among 3 groups.A nomogram was established based on determined risk factors or clinical features,and its accuracy in predicting MACE was ensured by using concordance index.Results Among 468 patients,there were 148(31.6%)patients with MACE.The results of LASSO regression analysis and multi-factor Cox screen showed that age,smoking,low-density lipoprotein-cholesterol(LDL-C),blood urea,and TyG were independent predictive factors for MACE in patients with ACS complicated by T2DM after PCI.The results of K-M analysis showed that MACE incidence increased with TyG increase in all TyG groups.The effect degree of all above influence factors on outcome variable was calculated and scored,then all scores were added up to get the total score,and risk scores were obtained in training set and validation set.In training set AUC was 0.729(95%CI:0.671~0.788)and in validation set AUC was 0.745(95%CI:0.654~0.836),which indicated that the nomogram had a higher accuracy in MACE prediction.Conclusion When TyG is higher,MACE risk will increase in patients with ACS complicated by T2DM after PCI.The nomogram,established according to determined variables,has some predictive value to MACE occurrence,and is worth clinical application.

关 键 词：急性冠状动脉综合征 甘油三酯-葡萄糖指数 经皮冠状动脉介入治疗 2型糖尿病 主要不良心血管事件 列线图 风险预测模型 

分 类 号：R541.4[医药卫生—心血管疾病]