甘油三酯-葡萄糖指数对行介入治疗的缺血性心力衰竭合并2型糖尿病患者的预后价值

Prognostic significance of the triglyceride-glucose index for patients with ischemic heart failure combined with type 2 diabetes mellitus after percutaneous coronary intervention

目的:在以往的研究中,甘油三酯-葡萄糖(triglyceride-glucose,TyG)指数已被证明与心血管疾病的预后密切相关。然而,TyG指数对接受PCI治疗的缺血性心力衰竭(heart failure,HF)合并2型糖尿病(type 2 diabetes mellitus,T2DM)患者预后的影响仍不明确。方法:回顾性纳入792例缺血性HF合并T2DM患者,并根据TyG指数的四分位数将其分为四组。主要终点是主要不良心血管事件(major adverse cardiovascular events,MACE),包括全因死亡、非致死性心肌梗死(myocardial infarction,MI)和任意血运重建。通过Kaplan-Meier生存分析评估四组间终点的发生率。使用多因素Cox回归模型分析TyG指数与终点的独立相关性。此外,进行了限制性立方样条(restricted cubic spline,RCS)分析,以检验TyG指数与MACE之间的非线性关系。结果:随着基线TyG水平增加,MACE的发生率显著增加(P<0.001)。Kaplan-Meier曲线同样表明:随着基线TyG水平增加,MACE的发生率显著增加(Log-rank P <0.001)。多因素Cox回归分析模型表明,随着基线TyG水平的增加,患者MACE(组1作为参考;组2 HR=1.24,95%CI:0.84~1.83,P=0.279;组3 HR=2.13,95%CI:0.1.47~3.08,P <0.001;组4 HR=2.55,95%CI:1.76~3.68,P <0.001)的发生风险显著增加。RCS曲线表明,TyG指数与MACE结局之间呈线性关系,MACE发生风险随着TyG水平的升高而升高(非线性P>0.05)。结论:在缺血性HF合并T2DM行PCI术的患者中,随着TyG水平升高,MACE发生率显著升高,二者呈线性关系。TyG指数同时也是该人群MACE的独立预测因素。本研究结果仍需在前瞻性研究中得到进一步证实。

Objective:Previous studies have established that the triglyceride-glucose(TyG)index is closely associated with the prognosis of cardiovascular diseases.However,the impact of the TyG index on the prognosis of patients with ischemic heart failure(HF)combined with type 2 diabetes mellitus(T2DM)undergoing PCI remains unclear.Methods:This retrospective study included 792 patients with ischemic HF and T2DM,divided into four groups based on quartiles of the TyG index.The primary endpoint was major adverse cardiovascular events(MACE),including all-cause mortality,non-fatal myocardial infarction(MI),and any revascularization.Kaplan-Meier survival analysis was used to assess the incidence of endpoints among the four groups.A multivariate Cox regression model analyzed the independent association of the TyG index with endpoints.Additionally,restricted cubic spline(RCS)analysis was conducted to examine the non-linear relationship between the TyG index and MACE.Results:The incidence of MACE significantly increased with higher baseline TyG levels(P<0.001).Kaplan-Meier curves similarly indicated a significant increase in MACE incidence with higher baseline TyG levels(Log-rank P<0.001).Multivariate Cox regression analysis revealed a significant increase in the risk of MACE with increasing baseline TyG levels(Group 1 as reference;Group 2 HR=1.24,95%CI:0.84-1.83,P=0.279;Group 3 HR=2.13,95%CI:1.47-3.08,P<0.001;Group 4 HR=2.55,95%CI:1.76-3.68,P<0.001).RCS curves showed a linear relationship between the TyG index and MACE outcomes,with the risk of MACE increasing as TyG levels increased(non-linearity P>0.05).Conclusions:In patients with ischemic HF and T2DM undergoing PCI,the incidence of MACE significantly increased with higher TyG levels,showing a linear relationship.The TyG index is also an independent predictor of MACE in this population.These findings require further confirmation in prospective studies.