摘要
背景 近年来我国糖尿病和心血管疾病患病人数逐年增加,已有研究证明了糖尿病可扩大心血管疾病的不良影响,涉及营养和炎症途径。预后营养指数(PNI)是免疫营养的标志,可反映个体的炎症、免疫状态和营养状况。由于其简单、快速、易得和可靠等优点,近年来关于PNI在各系统中的研究越来越多,但少有文献探讨PNI在心血管疾病中的作用。目的 本研究旨在探讨PNI与急性ST段抬高型心肌梗死(STEMI)合并2型糖尿病(T2DM)患者经皮冠状动脉介入(PCI)术后发生院内主要不良心血管事件(MACE)的关系。方法 回顾性分析2015年1月—2023年6月在新疆医科大学第一附属医院1 053例行PCI术的STEMI合并T2DM患者的临床资料。收集患者资料,计算PNI,根据患者住院期间是否发生MACE,分为MACE组(177例)和非MACE组(876例)。同时依据PNI预测STEMI合并T2DM患者行PCI术后发生院内MACE的截断值将患者分为高PNI组(686例)与低PNI组(367例)。采用单因素及多因素Logistic回归分析探究STEMI合并T2DM患者行PCI后发生院内MACE的影响因素。绘制受试者工作特征(ROC)曲线探究PNI对STEMI合并T2DM患者行PCI术后发生院内MACE的预测价值,计算曲线下面积(AUC)。采用Pearson相关性分析或Spearman秩相关分析探究PNI与心血管疾病危险因素之间的相关性。结果MACE组和非MACE组性别、年龄、高血压病史、血清葡萄糖、Killip分级、乳酸脱氢酶、心率、肌红蛋白、肌酸激酶-MB同工酶(CK-MB)、白细胞计数、脑钠肽(BNP)、PNI、全球急性冠脉事件注册(GRACE)评分、血红蛋白、血小板计数、淋巴细胞计数、白蛋白、总蛋白、肌酐、尿素氮、三酰甘油比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,血清葡萄糖升高(OR=1.055,95%CI=1.002~1.112,P=0.044)、GRACE评分高(OR=1.034,95%CI=0.876~0.939,P<0.001)是STEMI合并T2DM患者行PCI术后发生院内MACE的危险因素,PNI升高(OR=0.907,95%CI=1.017~1.050,P<0.001)是患者行PCI术后发生院内MACE的保护因素。PNI预测STEMI合并T2DM患者行PCI术后发生院内MACE的AUC为0.734(95%CI=0.694~0.773),通过Logistic回归分析构建预测模型,模型预测STEMI合并T2DM患者行PCI术后发生院内MACE的AUC为0.791(95%CI=0.753~0.858)。低PNI组发生MACE、主动脉内球囊反搏比例、住院天数、血清葡萄糖、肌钙蛋白T、CK-MB、肌红蛋白、BNP、C反应蛋白、肌酐、尿素氮高于高PNI组,光学相干断层扫描技术比例、总胆固醇、三酰甘油、HDL-C、血红蛋白低于高PNI组(P<0.05)。相关性分析结果显示,PNI与血红蛋白、HDL-C、总胆固醇、三酰甘油呈正相关(P<0.05);PNI与血清葡萄糖、肌酐、尿素氮、BNP、肌钙蛋白T、CK-MB、肌红蛋白、C反应蛋白呈负相关(P<0.05)。结论 PNI是STEMI合并T2DM患者PCI术后院内发生MACE的独立预测因素,临床中可作为监控患者免疫营养状态且预测患者短期预后的辅助指标。
Background The prevalence of diabetes and cardiovascular diseases in China has been increasing annually,and it has been demonstrated that diabetes can exacerbate the adverse effects of cardiovascular diseases through nutritional and inflammatory pathways.The prognostic nutritional index(PNI)is a marker of immunonutrition that reflects the inflammation,immune status and nutritional status of an individual.Due to its advantages of simplicity,rapidity,accessibility,and reliability,research on PNI has been increasing,yet its role in cardiovascular diseases has been less explored.Objective To investigate the relationship between PNI and major in-hospital adverse cardiovascular events(MACE)in patients with acute ST-elevation myocardial infarction(STEMI)complicated by type 2 diabetes mellitus(T2DM)following percutaneous coronary intervention(PCI).Methods A retrospective analysis of 1053 STEMI patients with T2DM who underwent PCI at the First Affiliated Hospital of Xinjiang Medical University from January 2015 to June 2023 was conducted.The patients were divided into the MACE(n=177)and non-MACE(n=876)groups according to the occurrence of MACE during hospitalization,and further categorized into the high PNI(n=686)and low PNI(n=367)groups according based on the cutoff value of PNI to predict the occurrence of in-hospital MACE after PCI in patients with STEMI and T2DM.Univariate and multivariate Logistic regression analyses identified factors influencing in-hospital MACE after PCI in patients with STEMI and T2DM.Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive value of PNI for in-hospital MACE,and the area under the curve(AUC)was calculated.Pearson correlation analysis or Spearman rank correlation analysis was used to explore the correlation between PNI and cardiovascular disease risk factors.Results The differences between the MACE and non-MACE groups in gender,age,history of hypertension,serum glucose,Killip classification,lactate dehydrogenase,heart rate,myoglobin,creatine kinase-MB isoenzyme(CK-MB),white blood cell count,brain natriuretic peptide(BNP),PNI,Global Registry of Acute Coronary Events(GRACE)score,hemoglobin,platelet count,lymphocyte count,albumin,total protein,creatinine,urea nitrogen and triacylglycerol were statistically significant(P<0.05).The results of multivariate Logistic regression analysis showed that elevated serum glucose(OR=1.055,95%CI=1.002-1.112,P=0.044)and higher GRACE score(OR=1.034,95%CI=0.876-0.939,P<0.001)were risk factors for in-hospital MACE,while increased PNI(OR=0.907,95%CI=1.017-1.050,P<0.001)was a protective factor.The AUC of PNI for predicting in-hospital MACE was 0.734(95%CI=0.694-0.773).A predictive model was constructed by Logistic regression analysis,and the model predicted an AUC of 0.791(95%CI=0.753-0.858)for the occurrence of in-hospital MACE after PCI in patients with STEMI complicated by T2DM.The low PNI group showed higher incidence of MACE and proportion of intra-aortic balloon counterpulsation,longer hospitalization duration,higher levels of serum glucose,troponin T,CK-MB,myoglobin,BNP,C-reactive protein,creatinine,and urea nitrogen than those in the high PNI group;and lower optical coherence tomography ratio,total cholesterol,triacylglycerol,HDL-C,and hemoglobin levels than those in the high PNI group(P<0.05).The results of correlation analysis showed that PNI was positively correlated with hemoglobin,HDL-C,total cholesterol,and triacylglycerol(P<0.05);PNI was negatively correlated with serum glucose,creatinine,urea nitrogen,BNP,troponin T,CK-MB,myoglobin,and C-reactive protein(P<0.05).Conclusion PNI is an independent predictive factor for in-hospital MACE in STEMI patients with T2DM after PCI,which can serve as an auxiliary indicator for monitoring patients'immunonutritional status and predicting their shortterm prognosis.
作者
赵帮豪
袁腾
赵翎
阿曼古丽·如则
尼鲁帕尔·谢甫开提
马依彤
杨毅宁
高晓明
ZHAO Banghao;YUAN Teng;ZHAO Ling;AMANGULI Ruze;NILUPAER Xiefukaiti;MA Yitong;YANG Yining;GAO Xiaoming(Department of Cardiology,the First Affiliated Hospital/State Key Laboratory of Pathogenesis/Prevention and Treatment of High Incidence Diseases in Central Asia/Clinical Medical Research Institute,Xinjiang Medical University,Urumqi 830054,China;Xinjiang Key Laboratory of Medical Animal Model Research,Urumqi 830054,China;People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)
出处
《中国全科医学》
CAS
北大核心
2024年第15期1817-1824,共8页
Chinese General Practice
基金
新疆重点实验室开放课题项目(2021D04020,2020D04027)
省部共建中亚高发病成因与防治国家重点实验室开放课题项目(SKL-HIDCA-2021-XXG1,SKL-HIDCA-2022-XXG1)。
关键词
ST段抬高型心肌梗死
糖尿病
2型
主要不良心血管事件
预后营养指数
预测价值
ST elevation myocardial infarction
Diabetes mellitus,type 2
Major adverse cardiovascular events
Prognostic nutritional index
Predictive value
