新的表示应激性高血糖的方法对ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后预后预测的价值

Prognostic value of new method expressing stress hyperglycemia in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention

目的探讨新的表示应激性高血糖的方法在ST段抬高型心肌梗死(ST-segment elevation myocardial in⁃farction,STEMI)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后两年发生主要不良心血管事件(major adverse cardiovascular event,MACE)的预测价值。方法总共纳入2018年1月至2019年3月同济大学附属同济医院经PCI治疗的STEMI患者389例,计算其入院时的随机血糖和基线血糖比值(acute-tobasic glycemic ratio,A/B)。根据A/B将患者分为低A/B组(0.55~1.03)、中A/B组(1.04~1.26)、高A/B组(1.27~3.43),比较3组患者的一般情况和随访2年的MACE。利用受试者工作特征曲线(receiver operating characteristic curve,ROC)评估A/B对STEMI患者PCI治疗后2年MACE发生的预测价值。结果3组患者MACE发生率比较,差异有统计学意义(P<0.05)。A/B预测患者2年病死率发生的最佳临界值为1.18,ROC曲线下面积(AUC)=0.74,95%CI:0.68~0.80,P<0.001;敏感性为71.10%,特异性为66.20%。多因素Logistic回归分析显示,A/B升高是STEMI患者PCI治疗后两年内发生MACE的独立预测因素(OR=4.512,95%CI:2.434~8.365,P<0.001)。结论A/B升高是STEMI患者PCI治疗后两年发生MACE的独立预测因素。将应激性高血糖纳入危险分层的同时,使用A/B的方法可精确识别真正的应激性高血糖,减少假阳性率。

Objectives To explore the predictive value of a new method expressing stress hyperglycemia on two-year major adverse cardiovascular event(MACE)in patients with ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods A total of 389 patients with STEMI who underwent PCI from January 2018 to March 2019 in Tongji Hospital were included,and the acute-to-basic glycemic ratio(A/B)was cal⁃culated.The patients were divided into low A/B group(0.55-1.03),medium A/B group(1.04-1.26)and high A/B group(1.27-3.43)according to A/B value.General situation and MACE followed for 2 years after PCI between the two groups were compared.Receiver operating characteristic curve(ROC)was used to assess the predictive value of A/B for 2-year MACE incidence after PCI in STEMI patients.Results There were significant differences in MACE incidences among the three groups(P<0.05).The optimal cut-off value for A/B predicting 2-year mortality was 1.18 and the area under the ROC(AUC)was 0.74,95%CI:0.68-0.80,P<0.001,sensitivity was 71.10%and specificity was 66.20%.Multivariate Logistic regression analysis showed that elevated A/B was an independent predictor for MACE in patients with STEMI within two years after PCI(OR=4.512,95%CI:2.434-8.365,P<0.001).Conclusions A/B elevation is an independent predictor for MACE in patients with STEMI after two years of PCI.While stress hyperglycemia is included in the risk strati⁃fication,the A/B method is used to accurately identify true stress hyperglycemia and reduce the false positive rate.