摘要
目的分析绝经后女性非ST段抬高型急性冠脉综合征(NSTE-ACS)患者中三酰甘油-葡萄糖(TyG)指数、三酰甘油-葡萄糖体质指数(TyG-BMI)指数和三酰甘油/高密度脂蛋白胆固醇(TG/HDL-C)比值与Gensini评分之间的相关性并进行比较。方法回顾性研究。纳入2021年10月至2023年10月在锦州医科大学附属第一医院心内科确诊为NSTE-ACS的绝经后女性患者共489例,平均年龄(66.0±7.3)岁。根据Gensini评分中位数,将患者分为低分组(Gensini评分<32分,241例)和高分组(Gensini评分≥32分,248例);根据患者慢性病种类,分为糖尿病亚组(138例)及非糖尿病亚组(351例)、高血压亚组(322例)及非高血压亚组(167例)、非ST段抬高型心肌梗死(NSTEMI)亚组(141例)及不稳定型心绞痛(UA)亚组(348例)。收集患者一般临床资料和入院后次日空腹状态下相关化验指标。采用单因素和多因素logistic回归分析Ty G指数、TyG-BMI指数和TG/HDL-C比值与Gensini评分之间的相关性,并进行亚组分析。绘制受试者工作特征曲线,分析并比较3个指标对冠状动脉病变程度的预测能力。采用Spearman秩相关分析比较3个指标与Gensini评分的线性关系。结果多因素logistic回归分析表明,TyG指数(OR=2.879,P=0.002)和TG/HDL-C比值(OR=1.168,P=0.005)是Gensini评分≥32分的独立危险因素,其中Ty G指数在不同亚组人群中仍是Gensini评分≥32分的独立危险因素,糖尿病亚组(OR=3.121,P=0.001)、高血压亚组(OR=3.120,P<0.001)、NSTEMI亚组(OR=3.622,P=0.006)、UA亚组(OR=2.728,P<0.001)。Ty G指数对Gensini评分≥32分的预测能力优于Ty G-BMI指数(P<0.05),但相较于TG/HDL-C比值,预测能力差异无统计学意义(P>0.05)。Ty G指数(r=0.436)、TyG-BMI指数(r=0.170)和TG/HDL-C比值(r=0.406)与Gensini评分均呈线性正相关(均为P<0.001)。Ty G指数和TG/HDL-C比值与Gensini评分的相关程度相似,但两者均优于Ty G-BMI指数。结论在绝经后女性NSTE-ACS患者中,TyG指数和TG/HDL-C比值是冠状动脉病变程度的独立危险因素。TyG指数和TG/HDL-C比值对Gensini评分≥32分的预测能力以及二者与Gensini评分的相关程度相似。
Objective To analyze and compare the relationships between TyG index,TyG-BMI index,TG/HDL-C ratio and Gensini score in postmenopausal femalenon-ST elevation acute coronary syndrome(NSTE-ACS)patients.Methods This retrospective study included a total of 489 postmenopausal female patients diagnosed with NSTE-ACS at the Department of Cardiovascular Medicine,First Affiliated Hospital of Jinzhou Medical University,from October 2021 to October 2023.The average age of the patients was 66.0±7.3 years.Based on the median Gensini score,the patients were categorized into two groups:low Gensini score group(score<32 points,n=241)and high Gensini score group(score≥32 points,n=248).Additionally,patients were subdivided according to their chronic disease status into diabetes subgroup(n=138),hypertension subgroup(n=322),NSTEMI subgroup(n=141),and UA subgroup(n=348).Clinical data of all patients were collected and compared.Single-factor and multi-factor binary logistic regression analyses were employed to investigate the correlations of TyG index,TyG-BMI index,and TG/HDL-C ratio with the Gensini score,alongside subgroup analyses.The receiver operating characteristic(ROC)curve was utilized to evaluate and compare the predictive capabilities of the three indicators regarding the severity of coronary artery disease.Furthermore,Spearman rank correlation analysis was conducted to assess the linear relationships between the three indicators and the Gensini score.Results Multivariate logistic regression analysis revealed that TyG index(OR=2.879,P=0.002)and TG/HDL-C ratio(OR=1.168,P=0.005)are independent risk factors for Gensini score≥32 points.Notably,TyG index remains an independent risk factor for a Gensini score≥32 points across various subgroups,including diabetes subgroup(OR=3.121,P=0.001),hypertension subgroup(OR=3.120,P<0.001),NSTEMI subgroup(OR=3.622,P=0.006),and UA subgroup(OR=2.728,P<0.001).The predictive ability of TyG index for Gensini score≥32 points is superior to that of TyG-BMI index(P<0.05);the difference in predictive ability compared to TG/HDL-C ratio is not statistically significant(P>0.05).The TyG index(r=0.436),TyG-BMI index(r=0.170),and TG/HDL-C ratio(r=0.406)all demonstrated a linear positive correlation with Gensini score(all P<0.001).The correlation of TyG index with Gensini score is comparable to that of TG/HDL-C ratio,both of which are stronger than the correlation exhibited by TyG-BMI index.Conclusions In postmenopausal female patients with NSTE-ACS,TyG index and TG/HDL-C ratio are identified as independent risk factors for the extent of coronary artery disease.The predictive capabilities of TyG index and TG/HDL-C ratio for Gensini score 32 points or higher,as well as their correlations with the Gensini score,are comparable.The relationship between TyG-BMI index and the degree of coronary artery disease warrants further investigation.
作者
李文锋
屈宝泽
刘明新
宋阳
张哲
Li Wenfeng;Qu Baoze;Liu Mingxin;Song Yang;Zhang Zhe(Department of Cardiology,the First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000,China;Department of Cardiology,Jinzhou Central Hospital,Jinzhou 121001,China)
出处
《中国心血管杂志》
北大核心
2024年第6期547-553,共7页
Chinese Journal of Cardiovascular Medicine
基金
辽宁省重点研发计划指导计划项目(2019JH8/10300037)。