修正休克指数与应激性高血糖对非糖尿病NSTEMI患者院内转归的预测价值

Prognostic value of modified shock index and stress hyperglycemia to nosocomial outcomes in non-diabetic patients with non-ST-segment elevation myocardial infarction

目的研究修正休克指数(MSI)与应激性高血糖(SHG)对非糖尿病急性非ST段抬高型心肌梗死(NSTEMI)患者院内转归的预测价值。方法选取2019年5月至2020年5月于徐州医科大学附属医院心内科首诊的非糖尿病NSTEMI患者336例为研究对象。根据患者入院24 h内MSI及空腹血糖结果,分为MSI<1.2组(n=290)与MSI≥1.2组(n=46)、无SHG组(空腹血糖<7.0 mmol/L,n=208)与SHG组(空腹血糖≥7.0 mmol/L,n=128)。记录患者一般资料,计算患者住院期间的MACE发生率及全因死亡率,分析MSI与SHG对非糖尿病NSTEMI患者院内转归的影响。结果MSI≥1.2组MACE发生率和全因死亡率显著高于MSI<1.2组,差异有统计学意义(P<0.05);SHG组MACE发生率和全因死亡率显著高于无SHG组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示MSI、空腹血糖、GRACE评分均为非糖尿病NSTEMI患者住院期间全因死亡的独立危险因素,其中MSI最强(OR=24.790,95%CI:4.483~137.081,P<0.001),空腹血糖次之(OR=1.149,95%CI:1.024~1.290,P=0.018)。MSI和空腹血糖的ROC曲线AUC分别为0.733(95%CI:0.595~0.872,P<0.001)和0.733(95%CI:0.633~0.833,P<0.001),对评估非糖尿病NSTEMI患者院内转归有统计学意义。结论MSI和SHG可期待作为评估非糖尿病NSTEMI患者住院期间心脏不良事件发生的预测指标。

Objective To study the prognostic value of modified shock index(MSI)and stress hyperglycemia(SHG)to nosocomial outcomes in non-diabetic patients with acute non-ST-segment elevation myocardial infarction(NSTEMI).Methods The non-diabetic patients with NSTEMI(n=336)were chosen from Department of Cardiology in Affiliated Hospital of Xuzhou Medical University from May 2019 to May 2020.The patients were divided,according to 24-h MSI,into MSI<1.2 group(n=290)and MSI≥1.2 group(n=46),and divided again,according to and fasting plasma glucose(FPG),into non-SHG group(FPG<7.0 mmol/L,n=208)and SHG group(FPG≥7.0 mmol/L,n=128).The general materials were recorded,and incidence rates of major adverse cardiovascular events(MACE)and all-cause mortality were calculated in all groups during hospitalization.The influences of MSI and SHG on nosocomial outcomes were analyzed in non-diabetic patients with NSTEMI.Results The incidence rates of MACE and all-cause mortality were significantly higher in MSI≥1.2 group than those in MSI<1.2 group(P<0.05).The incidence rates of MACE and all-cause mortality were significantly higher in SHG group than those in non-SHG group(P<0.05).The results of Logistic regression analysis showed that MSI,FPG and GRACE scores were independent risk factors of all-cause mortality in non-diabetic patients with NSTEMI during hospitalization,among them MSI was the highest(OR=24.790,95%CI:4.483~137.081,P<0.001)followed by FPG was secondary(OR=1.149,95%CI:1.024~1.290,P=0.018).The AUC of ROC curve of MSI was 0.733(95%CI:0.595~0.872,P<0.001)and that of FPG was 0.733(95%CI:0.633~0.833,P<0.001),which had statistical significance in reviewing nosocomial outcomes in non-diabetic patients with NSTEMI.Conclusion MSI and SHG can be taken as predictive indexes for reviewing MACE incidence in non-diabetic patients with NSTEMI during hospitalization.