糖化血清白蛋白水平与急性冠状动脉综合征患者经皮冠状动脉介入治疗术预后的相关性研究

Relationship between glycated albumin and prognosis in patients with acute coronary syndrome after percutaneous coronary intervention

目的:本研究的旨在研究经皮冠状动脉介入治疗(PCI)术后急性冠状动脉综合征(ACS)患者的糖化血清白蛋白(GA)水平与不良心血管事件关系,探究联合传统危险因素及GA预测PCI术后ACS患者预后的效果。方法:回顾性分析2018年6月至2019年8月,因ACS在我院住院期间接受PCI治疗的,年龄M18岁患者,采用Cox风险比例回归模型在多个模型中分析GA与主要不良心血管事件发生风险的相关性。采用ROC曲线评估传统危险因素联合或不联合GA预测MACCE事件的能力。结果:入选患者平均年龄为(59.9±10.1)岁,76.3%(1405例)为男性患者,平均BMI(26±3.2)kg/m^(2),41.8%(769例)有2型糖尿病病史。在患者出院后的18月随访期内共发生118例(6.4%)MACCE事件。将GA三分位数分组纳入多因素Cox比例风险回归模型分析显示,相比较于GA的第1三分位数组患者,第3三分位数组患者不良心血管事件的风险显著增加约2倍(中GA组如低GA组:HR=1.69,95%CI:0.81~3.55;高GA组込低GA组:HR=2.30,95%CI:1.30~4.04,P=0.014),即使在调整了传统危险因素以及HbA1C。Kaplan-Meier曲线分析显示GA三分位数分组患者不良心血管事件随时间的变化趋势差异有统计学意义,且与患者是否合并糖尿病无关。ROC曲线分析显示,传统危险因素联合GA预测MACCE发生风险的曲线下面积显著增加(AUC=0.665,95%CI:0.617~0.713,P<0.001)。结论:GA水平升高与经PCI术后的ACS患者发生MACCE事件密切相关,且与糖尿病状态以及HbA1C无关。另外联合传统危险因素及GA可能改善不良心血管事件发生风险的预测模型。

Objective:The study aimed to determine the relationship between plasma glycated albumin(GA)level and adverse cardiovascular events in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI)and to explore the effect of combined traditional risk factors and GA in predicting the prognosis of ACS patients after PCI.Methods:A retrospective analysis was conducted on patients aged 18 years or older who were hospitalized for ACS and received PCI in our hospital from June 2018 to August 2019.Cox proportional hazards regression model was used to analyze the correlation between GA and the risk of major adverse cardiovascular events in multiple models.Receiver operating characteristic(ROC)curve was used to evaluate the ability of traditional risk factors combined with or without GA to predict MACCE events.Results:the average age of the patients was(59.9±10.1)years old,76.3%(1405)were male,with an average BMI of(26±3.2)kg/m^(2),41.8%(769)had type 2 diabetes.During the follow-up period of 18 months after discharge,118(6.4%)MACCE events occurred.The result of multivariate Cox proportional hazards regression analysis showed that the risk of adverse cardiovascular events in patients with the third tertile group was about 2 times higher than that in patients with the first tertile group(middle GA group vs.low GA group:HR=1.69,95%CI:0.81~3.55;High GA group vs.low GA group:HR=2.30,95%CI:1.30-4.04,P=0.014),even after adjusting for traditional risk factors and HbA1c.ROC curve analysis showed that the area under the curve of traditional risk factors combined with GA in predicting the risk of MACCE increased significantly(AUC=0.665,95%CI:0.617-0.713,P<0.001).Conclusions:the elevated GA is closely related to the occurrence of MACCE events in ACS patients after PCI,and it is independent of diabetes status and HbA1C.In addition,the combination of traditional risk factors and GA may improve the prediction model of adverse cardiovascular events.