血清糖化白蛋白对急性心肌梗死冠状动脉介入患者长期预后的研究

Relationship between serum glycosylated albumin and long-term prognosis after percutaneous coronary intervention in patients with acute myocardial infarction

目的:评估血清糖化白蛋白(GA)对急性ST段抬高型心肌梗死(STEMI)患者PCI术后不良预后的预测价值。方法:本研究为回顾性队列研究,纳入2018年1月至2020年12月在平顶山市第二人民医院接受PCI的18~80岁STEMI患者,主要终点事件是包括全因死亡、非致命性心肌梗死、非致命性卒中或计划外的再次血运重建的复合终点。采用多变量COX比例风险回归模型评估GA与主要终点事件的相关性。结果:共有765例接受PCI的STEMI患者(平均年龄57.1岁;83.7%为男性)入选本研究。在平均17.2个月的随访期后共发生54个(7.1%)主要终点事件。当GA作为连续变量时,GA水平每增加1%,主要不良心脑血管事件(MACCE)风险增加9%(HR=1.09,95%CI:1.06~1.14,P <0.001)。当GA转化为分类变量并纳入模型中时,即使调整了HbA1C及血脂等传统危险因素后仍显示,较高的GA水平与主要终点事件的风险显著增加(中GA组vs.低GA组:HR=1.18,95%CI:0.56~2.60,P=0.64;高GA组vs.低GA组:HR=2.32,95%CI:1.17~4.60,P=0.016;P for trend <0.025)。结论:在接受PCI的STEMI患者中,GA水平与不良心血管事件发生风险显著相关。对于接受PCI的STEMI患者,GA是HbA1C的很好的补充,有助于临床医师更准确地为患者提供更好的治疗。

Objective:Glycosylated albumin(GA) may be a good substitute for FBG and HbA1c.However,there is no study to evaluate the correlation between GA and the prognosis of ST segment elevation myocardial infarction(STEMI) patients after percutaneous coronary intervention(PCI).Therefore,this study aims to evaluate the predictive value of GA on the poor prognosis of SETMI patients after PCI.Methods:This study was a retrospective cohort study,which included 18-80 year-old patients with acute ST segment elevation myocardial infarction who underwent PCI in PingDingShan Second People’s Hospital from January 2018 to December 2020.The primary end point was the composite end point of all-cause death,nonfatal myocardial infarction,nonfatal stroke or symptom driven revascularization.Multivariable Cox proportional hazards regression model was used to evaluate the correlation between glycated albumin and the primary endpoint.Results:a total of 54(7.1%)primary end points occurred after an average follow-up period of 17.2 months.When GA was used as a continuous variable,the risk of MACCE increased by 9% for every 1%increase in GA level(HR=1.09,95%CI:1.06-1.14,P<0.001).When GA was transformed into a categorical variable,it still showed that a higher GA level was associated with a significantly increased risk of primary endpoint events after adjusting for traditional risk factors such as HbA1c and blood lipids(medium GA group vs.low GA group:HR=1.18,95%CI:0.56-2.60,P=0.64;high GA group vs.low GA group:HR=2.32,95%CI:1.17-4.60,P=0.016;P for trend < 0.025).Conclusions:In STEMI patients undergoing PCI,GA level is significantly correlated with the risk of adverse cardiovascular events.For STEMI patients underwent PCI,GA is a good supplement to HbA1c,which helps clinicians provide better treatment for patients more accurately.