血糖波动对急性冠脉综合征患者近期主要心血管不良事件的预测价值

A Predictive Value of Blood Glycemic Variability on The Recent Major Cardiovascular Adverse Events in Acute Coronary Syndrom Patients

目的 探讨血糖波动对急性冠脉综合征(ACS)患者近期主要心血管不良事件(MACE)的预测价值。方法 连续选择2016年7月~2018年3月医院收治的247例ACS患者作为研究对象,按照30 d内是否发生MACE分为MACE组(n=28)和非MACE组(n=219),比较两组患者入院时一般资料、生化、超声和血糖波动指标的差异,采用Logistic回归分析ACS患者30 d内发生MACE的独立危险因素,ROC曲线分析血糖波动预测MACE的价值,Kaplan-Meier曲线分析患者30 d内发生MACE的累积概率。结果 MACE组三支病变发生率、入院时GRACE评分明显高于非MACE组,差异有统计学意义(P<0.05);与非MACE组比较,MACE组LVEDD、空腹血糖、BNP、CRP、血糖SD和MAGE明显升高,LVEF降低,差异有统计学意义(均P<0.05)。Logistic多因素回归分析显示,三支病变、GRACE评分、BNP、CRP、血糖SD、MAGE均是ACS患者30 d发生MACE的独立危险因素(P均<0.05)。血糖SD预测MACE的曲线下面积(AUC)为0.883(95CI:0.836~0.920,P<0.000 1),最佳临界值为2.07 mmol/L,敏感性为82.1%,特异性为79.5%;高于血糖波动界值的ACS患者30 d内发生MACE累积概率明显增加(P<0.05)。结论 血糖波动与ACS患者主要心血管不良事件风险密切相关,可作为早期评估患者不良预后的指标。

Objective To explore the predictive value of glycemic variability on the recent major cardiovascular adverse events in acute coronary syndrom patients.Methods From July 2016 to March 2018,a total of two hundred and fortyseven ACS patients in hospital were included.According to the 30-day follow-up whether occuring MACE,patients were classsfied into MACE group(n=28)and non-MACE group(n=219),the general clinical data,biochemistry and ultrasonic and glycemic variability indexes were compared between two groups,the independent risk factors of MACE during 30-day follow-up of ACS patients were analyzed by using Logistic regression analysis.The predictive value of glycemic variability on MACE was assessed by using ROC curve.Meanwhile,the survival analysis were implemented by using Kaplan-Meier.Results The triple-vessel disease,GRACE scores on admission in the MACE group were significantly higher than in the non-MACE group(P<0.05).Compared to the non-MACE group,the levels of LVEDD,fasting blood glucose,BNP,CRP,blood glucose standard deviation(BGSD),mean amplitude of glycemic excursion(MAGE)were increased and LVEF were decreased in the MACE group,the differences between the two groups were statistically significant(all P<0.05).Logistic regression analysis showed that triple-vessel disease,GRACE scores,BNP,CRP,BGSD,MAGE were independent risk factors for MACE in ACS patients during 30-day follow-up(all P<0.05).The ROC curve analysis showed that BGSD predicted MACE with AUC was 0.883(95CI:0.836~0.920,P<0.0001),the cut-off value were 2.07 mmol/L,which yield sensitivity and specificity were 82.1%and 79.5%,respectively.The cumulative risk of MACE during 30-day follow-up increased markedly who over the cut-off value of glycemic variability(P<0.05).Conclusion There is closely correlation between glycemic variability and recent major cardiovascular adverse events in acute coronary syndrom patients,its can be used as a factor for the poor prognosis of patients.