糖尿病合并急性冠脉综合征患者血糖水平预测冠脉病变程度及心血管不良事件的价值

Value of Blood Glucose Levels in Predicting the Extent of Coronary Artery Disease and Major Adverse Cardiovascular Events in Patients with Diabetes Mellitus and Acute Coronary Syndrome

目的:探讨糖尿病(DM)合并急性冠脉综合征(ACS)患者血糖水平预测冠脉病变程度及心血管不良事件(MACE)的价值。方法:选取医院2021年5月至2022年5月收治的65例DM合并ACS患者,根据冠脉病变支数分为轻度狭窄组(23例)、中度狭窄组(22例)与重度狭窄组(20例);同时根据是否发生心血管不良事件分为MACE组(20例)与非MACE组(45例)。观察比较各组血糖水平、冠脉病变程度Gensini评分,受试者工作特征(ROC)曲线分析血糖水平预测冠脉病变程度及心血管不良事件的价值。结果:重度狭窄组Gensini评分及糖化血清蛋白(GSP)、胰岛素样生长因子-1(IGF-1)、血清甘油三酯-血糖指数(TG-G)水平显著高于中度狭窄组及轻度狭窄组(P<0.05),中度狭窄组Gensini评分及GSP、IGF-1、TG-G水平显著高于轻度狭窄组(P<0.05);非MACE组GSP、IGF-1、TG-G水平均显著低于MACE组(P<0.05);建立ROC曲线,血清GSP、IGF-1、TG-G水平联合诊断DM合并ACS患者发生冠脉重度狭窄的灵敏度、特异度、曲线下面积(AUC)分别为78.0%、86.7%、0.816,联合诊断DM合并ACS患者MACE的灵敏度、特异度、AUC分别为90.0%、71.1%、0.789,均高于单个指标的诊断效能(P<0.05)。结论:DM合并ACS患者的血糖水平对冠脉病变程度及MACE有一定的预测价值。

Objective:To evaluate the value of blood glucose levels in predicting the extent of coronary artery disease and major adverse cardiovacsular events(MACE)in patients with diabetes mellitus(DE)and acute coronary syndrome(ACS).Methods:Sixty-five patients with DE and ACS in the hospital from May 2021 to May 2022 were selected.Patients were classified into mild stenosis(n=23),moderate stenosis(n=22)and severe stenosis(n=20)groups according to the severity of coronary artery disease.Patients were re-divided into MACE group(n=20)and non-MACE group(n=45)according to the presence or absence of MACE.Blood glucose level and Gensini score of coronary artery lesion were observed and compared in each group.Then receiver operating characteristic(ROC)curve was plotted to assess the value of blood glucose level in predicting the degree of coronary artery disease and MACE.Results:Among patients with different severity degrees of coronary artery disease,the Gensini score,glycosylated serum protein(GSP),insulin-like growth factor-1(IGF-1)and serum triglyceride glycemic index(TG-G)were the highest in severe stenosis group,followed by moderate stenosis group and mild stenosis group,with statistical difference(P<0.05).The GSP,IGF-1,and TG-G indexes in non-MACE group were significantly lower than those in MACE group(P<0.05).ROC curve was established,and the sensitivity,specificity and area under the curve(AUC)of serum GSP,IGF-1 and TG-G index in the combined diagnosis of severe coronary artery stenosis in DM patients with ACS were 78.0%,86.7%and 0.816,respectively.The and AUC of the combined diagnosis of cardiovascular adverse events in DM patients with ACS were 90.0%,71.1%and 0.789,respectively,which were higher than the diagnostic efficacy of a single index(P<0.05).Conclusion:The blood glucose level in patients with DE and ACS has a certain value in predicting the degree of coronary lesions and MACE.