急性ST段抬高型心肌梗死合并2型糖尿病患者PCI术预后与平均血糖波动幅度的相关性

Correlation between PCI prognosis and MAGE in acute STEMI patients with type 2 diabetes mellitus

目的 研究急性ST段抬高型心肌梗死(STEMI)合并2型糖尿病患者经皮冠状动脉介入(PCI)术后短期预后与平均血糖波动幅度(MAGE)的相关性。方法 选择2018年1月—2021年9月中国人民解放军联勤保障部队第九〇一医院收治的92例行急诊PCI治疗的急性STEMI合并2型糖尿病患者作为研究对象,根据术后1个月内患者是否发生主要心血管不良事件判断患者预后,分为预后良好组(60例)和预后不良组(32例)。收集所有患者一般资料,包括性别、年龄、体质量指数(BMI)、有无并发症(高血压、高脂血症、脑卒中)、Killip分级、病变支数、梗死部位。检测总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、左室射血分数(LVEF)、N末端脑钠肽前体(NT-proBNP)、MAGE、最大血糖波动幅度(LAGE)、空腹血糖等指标。以受试者工作特征(ROC)曲线分析LVEF、MAGE、LAGE、FBG水平预测急性STEMI合并2型糖尿病患者PCI术后短期预后不良的价值;采取非条件Logistic逐步回归分析急性STEMI合并2型糖尿病患者PCI术后短期预后不良的危险因素。结果 与预后良好组相比,预后不良组多支病变的患者比例较高,并且预后不良组LVEF水平较低,MAGE、LAGE、FBG水平较高(P<0.05);经ROC分析,LVEF≤57.162%、MAGE≥4.629 mmol/L、LAGE≥2.715 mmol/L、FBG≥9.366 mmol/L是预测急性STEMI合并2型糖尿病患者PCI术后短期预后不良的最佳截断值(均P<0.05);多因素Logistic回归性分析显示,多支病变、LVEF≤57.162%、MAGE≥4.629 mmol/L、LAGE≥2.715 mmol/L、FBG≥9.366 mmol/L是急性STEMI合并2型糖尿病患者PCI术后短期预后不良的危险因素(均P<0.05)。结论 急性STEMI合并2型糖尿病患者PCI术后短期预后与MAGE水平呈负相关,此外多支病变、LVEF偏低、高MAGE、高LAGE、高FBG可能是患者PCI术后短期预后不良的危险因素,使用MAGE预测PCI术后短期预后具有较高的敏感度和特异性,可将其作为临床评估患者预后的参考指标。

Objective To study the correlation between short-term prognosis and mean glucose fluctuation(MAGE)after percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI)complicated with type 2 diabetes mellitus.Methods A total of 92 patients with acute STEMI and type 2 diabetes who underwent PCI in our hospital from January 2018 to September 2021 were selected as the research subjects.All patients underwent emergency PCI,according to whether patients with postoperative 1 months gave birth to judge the prognosis of patients with major adverse cardiovascular events,divided into good prognosis group(60 cases)and poor prognosis group(32 cases).General data of all patients were collected,including gender,age,BMI,complications(hypertension,hyperlipidemia,stroke),Killip grade,number of lesions,and infarct site.Total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),left ventricular ejection fraction(LVEF),N-terminal brain natriuretic peptide precursor(NT-probNP),MAGE,maximum blood glucose fluctuation(LAGE),fasting blood glucose and other indicators were detected.ROC curve analysis of LVEF,MAGE,LAGE and FBG levels in predicting short-term poor prognosis in patients with acute STEMI complicated with type 2 diabetes after PCI;the risk factors for poor short-term prognosis in patients with acute STEMI complicated with type 2 diabetes after PCI were analyzed by conditional Logistic stepwise regression.Results Compared with the good prognosis group,the proportion of patients with multiple lesions was higher in the poor prognosis group,and the LVEF level was lower in the poor prognosis group,and the MAGE,LAGE and FBG levels were higher(P<0.05);according to ROC analysis,LVEF≤57.162%,MAGE≥4.629 mmol/L,LAGE≥2.715 mmol/L and FBG≥9.366 mmol/L were the best cut-off values for predicting poor short-term prognosis in patients with acute STEMI combined with type 2 diabetes after PCI(P<0.05).Multivariate Logistic regression analysis showed that multi-vessel disease,LVEF≤57.162%,MAGE≥4.629 mmol/L,LAGE≥2.715 mmol/L,FBG≥9.366 mmol/L were risk factors for poor short-term prognosis in patients with acute STEMI complicated with type 2 diabetes after PCI(P<0.05).Conclusion The short-term prognosis of acute STEMI patients with type 2 diabetes after PCI was negatively correlated with MAGE level.High MAGE level may be a risk factor for poor short-term prognosis of patients after PCI.Using MAGE to predict short-term prognosis after PCI has high sensitivity and specificity,which can be used as a reference index for clinical evaluation of patient prognosis.