甘油三酯-葡萄糖指数对急性心肌梗死患者经皮冠状动脉介入治疗后长期预后的影响

Influence of triglyceride-glucose index on long-term prognosis after percutaneous coronary intervention in patients with acute myocardial infarction

摘要:

目的 评估甘油三酯-葡萄糖指数（triglyceride-glucose index，TyG指数）对接受经皮冠状动脉介入治疗的急性心肌梗死（acute myocardial infarction，AMI）患者长期主要不良心血管事件（major adverse cardiovascular events，MACE）的预测作用。方法 回顾性分析2012年12月至2018年10月连续收治于北京石景山医院诊断为AMI并行经皮冠状动脉介入治疗的患者。TyG指数计算公式为：ln［空腹甘油三酯（mg/dL）×空腹血糖（mg/dL）/2］。根据TyG指数三分位数将患者分为3组，记录其临床、实验室资料及MACE（包括全因死亡、非致死性心肌梗死或再次血运重建）。采用Cox风险回归分析进行单因素和多因素分析。结果 临床中位随访时间为31（21~41）个月，随访中死亡45例（9.3%），发生MACE事件91例（24.2%）。随着TyG指数的增高，MACE发生率明显增高（P=0.027）。发生MACE的患者年龄更大，有更高水平的TyG指数、空腹血糖、糖化血红蛋白（glycated hemoglobin，HbA1c）和尿酸，既往有糖尿病史、脑血管病史、Killip分级大于1和三支病变所占的比例更高。多因素Cox回归分析表明，校正其他因素后，TyG指数是长期（1年以上）死亡率的独立预测因子（HR=1.656，95%CI=1.226~2.237；P=0.001）。Kaplan-Meier分析显示，高TyG指数组患者发生MACE事件的生存率最低（P=0.011）。结论 TyG指数是接受经皮冠状动脉介入治疗的AMI患者长期MACE事件发生的独立预测因子。

Abstract:

Objective To evaluate the predictive role of triglyceride-glucose index（TyG index） in long-term major adverse cardiovascular events（MACE） in patients with acute myocardial infarction（AMI） undergoing percutaneous coronary intervention.Methods Patients with AMI undergoing percutaneous coronary intervention who were admitted to Beijing Shijingshan Hospital from December 2012 to October 2018 were retrospectively analyzed. The formula for TyG index was： ln［fasting triglyceride（mg/dL） × fasting blood glucose（mg/dL）/2］. Patients were divided into three groups based on TyG index tertiles，and their clinical and laboratory data and MACE （including all-cause death，non-fatal myocardial infarction， or re-vascularization） were recorded. Cox risk regression analysis was used for univariate and multivariate analysis.Results The median follow-up time was 31（21-41） months，45 cases（9.3%） died and 91 cases（24.2%） had MACE. With the increase of TyG index， the incidence of MACE significantly increased（P=0.027）. Patients with MACE were older， and had higher levels of TyG index，fasting blood glucose，glycated hemoglobin（HbA1c） and uric acid. In addition，older patients had a higher proportion of previous diabetes，cerebrovascular history，Killip grade > 1 and three-vessel lesions. TyG index was an independent predictor of long-term （more than 1 year） mortality after adjustment for other confounders in multivariate Cox regression analysis（HR=1.656；95%CI=1.226-2.237；P=0.001）. Kaplan-Meier analysis showed that patients with high TyG index had the lowest survival rate of MACE（P=0.011）.Conclusion TyG index is an independent predictor of long-term MACE in AMI patients undergoing percutaneous coronary intervention.