甘油三酯葡萄糖指数和血浆致动脉粥样硬化指数对冠心病患者经皮冠状动脉介入治疗后再次血运重建的预测价值
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(1.解放军医学院,北京 100853;2.中国人民解放军总医院第一医学中心心血管内科,北京100853)

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R541.4

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中华心血管病发展专项基金(Z-2019-42-1908-2)


Predictive value of triglyceride-glucose index and atherogenic index of plasma for revascularization events in coronary artery disease patients after percutaneous coronary intervention
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(1.Medical School of Chinese PLA, Beijing 100853, China;2.Department of Cardiology, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China)

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    摘要:

    目的 探讨甘油三酯葡萄糖(TyG)指数和血浆致动脉粥样硬化指数(AIP)对冠心病患者经皮冠状动脉介入治疗(PCI)后再次血运重建的预测价值。方法 回顾性分析2018年1月至2020年1月于中国人民解放军总医院第一医学中心接受药物洗脱支架植入后进行冠状动脉造影复查的787例冠心病患者的临床资料。根据是否需要再次血运重建,将患者分为再次血运重建组(315例)和非再次血运重建组(472例)。使用SPSS 25.0和R 4.1.3软件进行统计分析。根据数据类型,组间比较分别采用秩和检验、χ2检验或Fisher精确检验。采用单变量Cox回归分析再次血运重建的影响因素。采用多变量Cox比例风险回归分析TyG指数和AIP是否为再次血运重建的独立预测因子。绘制时间依赖性受试者工作特征(ROC)曲线,并使用曲线下面积(AUC)分析TyG指数和AIP对冠心病患者PCI后再次血运重建的预测价值。结果 再次血运重建组与非再次血运重建组左室射血分数、吸烟史、白细胞计数、血小板计数、空腹血糖、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、系统性免疫炎症指数(SII)、TyG指数和AIP比较,差异均有统计学意义(均P<0.05)。单变量Cox回归分析发现,吸烟史、心房颤动、白细胞计数、血小板计数、空腹血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、SII、TyG指数及AIP是再次血运重建的危险因素,左室射血分数、高密度脂蛋白胆固醇是再次血运重建的保护因素。多变量Cox比例风险回归分析显示,在调整混杂因素后,TyG指数和AIP的增加仍与再次血运重建风险相关。Kaplan-Meier生存曲线分析显示,再次血运重建的累计发病率在TyG指数和AIP的第三分位数组明显高于第一及第二分位数组(均Plog-rank<0.001)。时间依赖性ROC曲线分析显示,TyG指数预测再次血运重建的AUC为0.571~0.618,AIP预测再次血运重建的AUC为0.573~0.605,TyG指数与AIP联合预测再次血运重建的AUC为0.577~0.614。结论 TyG指数和AIP对冠心病患者PCI后再次血运重建事件有较好的预测价值。

    Abstract:

    Objective To explore the predictive value of triglyceride-glucose (TyG) index and atherogenic index of plasma (AIP) for revascularization after percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD). Methods A retrospective analysis was conducted on 787 CHD patients undergoing coronary angiography in follow-up after drug-eluting stent implantation at the First Medical Center of Chinese PLA General Hospital from January 2018 to January 2020. According to need for revascularization or not, they were divided into a revascularization group (315 cases) and a non-revascularization group (472 cases). SPSS 25.0 and R 4.1.3 software were used for statistical analysis. Based on data type, rank sum test, Chi-square test or Fisher exact test was used for comparison between groups. Univariate Cox regression analysis was utilized to analyze the influencing factors for revascularization, and multivariate Cox proportional hazard regression analysis was applied to analyze whether TyG index and AIP are independent predictors of revascularization. A time-dependent receiver operating characteristics (ROC) curve was plotted, and the area under the curve (AUC) was employed to identify the predictive values of TyG index and AIP for revascularization after PCI. Results There were significant differences between the revascularization group and the non-revascularization group in terms of left ventricular ejection fraction (LVEF), smoking history, white blood cell (WBC) count, platelet (PLT) count, fasting blood glucose (FBG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systemic immune-inflammation index (SII), TyG index, and AIP (all P<0.05). Univariate Cox regression analysis found that, history of atrial fibrillation, smoking history, WBC count, PLT count, FBG, TC, TG, LDL-C, SII, TyG index, and AIP were risk factors for revascularization, while LVEF and HDL-C was a protective factor for revascularization. Multivariate Cox proportional hazards regression analysis showed that after adjusting for confounding factors, the increases in TyG index and AIP were still associated with the risk of revascularization. Kaplan-Meier survival curve analysis indicated that the cumulative incidence rate of revascularization was significantly higher in the third quantile array of TyG index and AIP than in the first and second quantile arrays (all Plog rank<0.001). Time-dependent ROC curve analysis revealed that in predicting revascularization, the AUC value of TyG index ranged from 0.571 to 0.618, that of AIP predicts was from 0.573 to 0.605, and the value of their combination was from 0.577 to 0.614 for revascularizatio. Conclusion TyG index and AIP have good predictive value for revascularization events in CHD patients after PCI.

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吴迅,崔建国,杨霞,钱赓,金琴花.甘油三酯葡萄糖指数和血浆致动脉粥样硬化指数对冠心病患者经皮冠状动脉介入治疗后再次血运重建的预测价值[J].中华老年多器官疾病杂志,2024,23(5):321~326

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  • 收稿日期:2023-11-16
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  • 在线发布日期: 2024-05-15
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