2型糖尿病心脏Tei指数与B型氨基端利钠肽原和糖化血红蛋白的关系及联合预测主要不良心血管事件的价值

Relationship between cardiac Tei index and plasma amino terminal brain natriuretic peptide precursor, glycosylated hemoglobin in type 2 diabetes mellitus and its combined prediction value for major adverse cardiovascular events

目的 探讨2型糖尿病心脏Tei指数与B型氨基端利钠肽原（NT-proBNP）和糖化血红蛋白（HbA1c）的关系及联合预测主要不良心血管事件（MACE）的价值.方法 回顾分析2015年3月至2017年10月收治的160例2型糖尿病患者的临床资料.根据患者是否发生MACE分为MACE组（45例）和非MACE组（115例）.对比分析两组的临床资料,并分析心脏Tei指数与NT-proBNP和HbA1c的关系,采用Logistic回归分析影响2型糖尿病患者发生MACE的危险因素.结果 MACE组收缩压、舒张压明显低于非MACE组[（109.10±14.53）mmHg（1 mmHg=0.133 kPa）比（120.76±18.74）mmHg和（64.29±9.82）mmHg比（73.58±12.11）mmHg],心率、Killip等级〉Ⅱ级率、心脏Tei指数和NT-proBNP明显高于非MACE组[（77.56±13.36）次/min比（71.68±11.39）次/min、28.89％（13/45）比2.61％（3/115）、0.63±0.12比0.52±0.08和（1193.20±145.69）μg/L比（823.87±89.22）μg/L],差异有统计学意义（P〈0.01）.Pearson相关性分析结果显示,心脏Tei指数与NT-proBNP和HbA1c均呈正相关（r=0.817、0.793,P〈0.05）;NT-proBNP与HbA1c也呈正相关（r=0.649,P〈0.05）.Logistic回归分析结果显示,心脏Tei指数、NT-proBNP和HbA1c为2型糖尿病患者发生MACE的独立危险因素（OR=1.015、1.041和1.027,95％CI 1.005～0.213、1.012～7.036和1.002～4.222,P〈0.01或〈0.05）.结论 2型糖尿病患者心脏Tei指数与NT-proBNP和HbA1c呈正相关,且均是MACE发生的危险因素,三者联合可有效预测MACE的发生、判定预后.

Objective To investigate the relationship between cardiac Tei index and plasma amino terminal brain natriuretic peptide precursor （NT- proBNP）, glycosylated hemoglobin （HbA1c） in type 2 diabetes mellitus and its value in predicting the occurrence of major adverse cardiovascular events （MACE）. Methods The clinical data of 160 patients with type 2 diabetes mellitus from March 2015 to October 2017 were retrospectively analyzed. The patients were divided into MACE group （45 cases） and non-MACE group （115 cases）. The clinical indexes were compared between 2 groups, and the relationship between cardiac Tei index and NT-proBNP, HbA1c was analyzed. Logistic regression analysis was used to analyze the risk factors of MACE in patients with type 2 diabetes mellitus. Results The systolic blood pressure and diastolic blood pressure in MACE group were significantly lower than those in non-MACE group： （109.10 ± 14.53） mmHg （1 mmHg = 0.133 kPa） vs. （120.76 ± 18.74） mmHg and （64.29 ± 9.82） mmHg vs. （73.58 ± 12.11） mmHg, the heart rate, Killip grade 〉 Ⅱ rate, cardiac Tei index and NT- proBNP were significantly higher than those in non- MACE group： （77.56 ± 13.36） times/min vs. （71.68 ± 11.39） times/min, 28.89% （13/45） vs. 2.61% （3/115）, 0.63 ± 0.12 vs. 0.52 ± 0.08 and （1193.20 ± 145.69） μg/L vs. （823.87 ± 89.22） μg/L, and there were statistical difference （P〈0.01）. Pearson regression analysis result showed that cardiac Tei index was positively correlated with NT- proBNP and HbA1c （r = 0.817 and 0.793, P 〈 0.05）, and there was positive correlation between NT-proBNP and HbA1c （r = 0.649, P 〈 0.05）. Logistic regression analysis result showed that cardiac Tei index, NT-proBNP and HbA1c were the independent risk factors of MACE in patients with type 2 diabetes mellitus （OR = 1.015, 1.041 and 1.027; 95% CI 1.005 to 0.213, 1.012 to 7.036 and 1.002 to 4.222; P〈0.01 or 〈0.05）. Conclusions The cardiac Tei index has positive correlation with NT- proBNP and HbA1c in patients with type 2 diabetes mellitus, and both are risk factors for the occurrence of MACE. The combination of the 3 indexes can effectively predict the occurrence of MACE and assess the prognosis.