TyG指数与急性心肌梗死合并心源性休克SCAI分期和预后的相关性分析  

Analysis of TyG index on SCAI shock classification and prognosis in patients with acute myocardial infarction-related cardiogenic shock

作　　者：夏亚楠 刘湘国 林惠 王艳真 边圆[1,2] 徐峰 Xia Yanan;Liu Xiangguo;Lin Hui;WangYanzhen;Bian Yuan;Xu Feng(Department of Emergency Medicine,Qilu Hospital of Shandong University;Shandong Provincial Clinical Research Center for Emergency and CriticalCare Medicine,Jinan,China.)

机构地区：[1]山东大学齐鲁医院急诊科 [2]山东省急危重症临床医学研究中心

出　　处：《实用休克杂志(中英文)》2024年第6期328-335,共8页Journal of Practical Shock

基　　金：山东省重点研发计划(项目编号:2022CXGC010504;2024CXPT089)

摘　　要：目的 分析甘油三酯-葡萄糖(TyG)指数与急性心肌梗死相关心源性休克(AMICS)患者病情严重程度及院内死亡率之间的相关性。方法 回顾性分析2017年1月至2023年12月山东大学齐鲁医院因AMI导致CS患者的临床资料,根据SCAI分期将其分为B期组和CDE期组,根据TyG指数三分位数将其分为Q1组、Q2组和Q3组,采用限制性立方样条(RCS)、受试者工作特征(ROC)曲线下面积(AUC)、Logistic回归分析TyG指数对SCAI分期及院内死亡率的影响。结果 根据SCAI分期,B期243例,CDE期349例,CDE期的TyG指数明显高于B期(9.01vs.8.82,P=0.001)。根据TyG指数三分位数,Q1组192例,Q2组200例,Q3组200例。RCS分析显示TyG指数与AMICS患者院内死亡(非线性P=0.004)及SCAI分期严重程度(非线性P=0.022)呈非线性关系。ROC曲线显示,单独TyG指数预测AMICS院内死亡的AUC为0.562(95%CI:0.509~0.615),预测SCAI分期严重程度的AUC为0.577(95%CI:0.532~0.623)。多因素Logistic回归分析显示,乳酸(Lac)、左室射血分数(LVEF)、血运重建、高密度脂蛋白胆固醇(HDL-C)是AMICS患者院内死亡的独立影响因素(P<0.05),而TyG指数并非其独立影响因素。结论 AMICS患者中高TyG指数与SCAI分期严重程度及院内死亡率相关,但并非其独立危险因素。Objective To analyze the correlation between triglyceride-glucose(TyG)index and severity and in-hospital mortality in patients with acute myocardial infarction-related cardiogenic shock(AMICS).Methods The clinical data of patients diagnosed with AMICS at Qilu Hospital of Shandong University from January 2017to December 2023were analysed retrospectively.According to the SCAI shock classification,they were divided into B stage and CDE stage group,and according to the tertiles of TyG index,they were divided into Q1,Q2and Q3group.Restricted cubic spline(RCS),area under the receiver operating characteristic(ROC)curve(AUC)and Logistic regression were used to analyze the effect of TyG index on SCAI stage and in-hospital mortality.Results According to SCAI classification,243cases were stage B and 349cases were stage CDE.The TyG index of CDE stage was significantly higher than that of B stage(9.01vs.8.82,P=0.001).According to the tertiles of TyG index,there were 192cases in Q1group,200cases in Q2group,and 200cases in Q3 group.RCS analysis showed that TyG index had a nonlinear relationship with in-hospital mortality(P for nonlinear=0.004)and the severity of SCAI stage(P for nonlinear=0.022).The ROC curve showed that the AUC of TyG index alone for predicting in-hospital mortality was 0.562(95%CI:0.509~0.615),and the AUC for predicting the severity of SCAI stage was 0.577(95%CI:0.532~0.623).Multivariate logistic regression analysis showed that Lac,LVEF,revascularization and HDLC were independent influencing factors for in-hospital mortality in AMICS patients(P<0.05),while TyG index was not an independent influencing factor.Conclusions Higher TyG index in AMICS patients is associated with SCAI stage and in-hospital mortality,but it is not an independent risk factor.

关 键 词：TyG指数 急性心肌梗死 心源性休克 SCAI分期 

分 类 号：R542.22[医药卫生—心血管疾病] R541.64[医药卫生—内科学]