高敏肌钙蛋白与2型糖尿病伴肾功能不全的慢性冠状动脉综合征患者冠状动脉介入治疗预后的分析

The relationship between normal range of high-sensitivity troponin Ⅰ and cardiovascular risk in patients with chronic coronary syndrome with type 2 diabetes mellitus and renal insufficiency undergoing percutaneous coronary intervention

目的:本研究旨在探究2型糖尿病伴肾功能不全的慢性冠状动脉综合征(CCS)男性患者中正常范围内hs-TnⅠ与不良心血管事件的相关性。方法:纳入2018年1月至2018年12月,在唐山市人民医院接受经皮冠状动脉介入治疗18~80岁糖尿病合并肾功能不全的CCS的男性患者,收集患者的人口统计学特征、既往病史以及心血管病高危因素、实验室指标以及造影手术资料,主要观察终点事件包括:全因死亡、非致命性心肌梗死、非致命性卒中或因心绞痛再次住院的复合终点。使用对数秩检验以及Cox比例风险回归模型评估hs-TnⅠ与不良心血管事件的关系。结果:共纳入257例患者,入选患者平均年龄(66.1±9.6)岁,平均BMI(26.1±3.31)kg/m2,18个月的随访期间共发生26例(10.1%)主要终点事件。多因素Cox比例风险回归分析结果,显示在调整相关危险因素后hs-TnⅠ每增加一个单位,主要终点事件的发生风险增加12%(HR=1.12, 95%CI:1.03~1.20,P<0.004)。将hs-TnⅠ进行三分位转换为分类变量纳入多因素Cox比例风险回归模型分析发现,以hs-TnⅠ的第1三分位数作为参照,高hs-TnⅠ水平患者不良心血管事件的风险显著增加(T2 vs. T1:HR=2.47,95%CI:0.65~9.45;T3 vs. T1:HR=4.35,95%CI:1.24~15.29,P<0.045)。结论:本研究表明在患有糖尿病合并肾功能不全的CCS男性患者中,正常范围内高hs-TnⅠ的浓度与主要不良心血管事件密切相关,且与传统危险因素无显著关系。hs-TnⅠ检测作为稳定CCS患者临床决策的辅助手段具有潜在价值,但仍需要更多的数据的支持。

Objective: This study aims to investigate the relationship between normal range of high-sensitivity troponin Ⅰ(hs-TnⅠ) levels and adverse cardiovascular events in male patients with chronic coronary syndrome(CCS) with type 2 diabetes mellitus and renal insufficiency undergoing percutaneous coronary intervention(PCI). Methods: we enrolled male patients aged 18-80 with CCS with type 2 diabetes and renal insufficiency undergoing PCI in tangshan people’s hospital from January 2018 to December 2018. The demographic characteristics, past medical history, cardiovascular risk factors, laboratory parameters and angiographic data were collected. The primary outcome was the composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization due to angina pectoris. Log rank test and Cox proportional hazard regression model were used to evaluate the relationship between hs-TnⅠ and adverse cardiovascular events. Results: A total of 257 patients were enrolled [age(66.1 ±9.6)years, BMI(26.1 ±3.31)kg/m2, HbA1 c(7.1±0.99)%]. A total of 26(10.1%) events occurred during the 18-month follow-up period. After fully adjusted, each unit increase in hs-TnⅠ was associated with a 12% increased risk of cardiovascular events(HR=1.12, 95%CI:1.03-1.20, P<0.004). When the overall population was stratified by tertiles of hs-TnⅠ, patients with high hs-TnⅠ levels had a significantly high risk of adverse cardiovascular events(T2 vs. T1:HR=2.47,95%CI:0.65-9.45;T3 vs. T1:HR=4.35,95%CI:1.24-15.29,P<0.045). Conclusions: In male patients with CCS with type 2 diabetes mellitus and renal insufficiency undergoing PCI, higher levels of hs-TnⅠ within the normal range were closely related to cardiovascular events independent of traditional risk factors.