ST段抬高型心肌梗死患者应激性高血糖比值对新发心房颤动的影响

Effect of stress hyperglycemia ratio in patients with ST-segment elevation myocardial infarction on the new-onset atrial fibrillation

目的:探索应激性高血糖比值(stress hyperglycemia ratio,SHR)对ST段抬高型心肌梗死患者(ST-segment elevation myocardial infarction,STEMI)新发心房颤动(new-onset atrial fibrillation,NOAF)的预测价值。方法:本研究为回顾性队列研究,入选2018年6月至2020年1月,于上海市第二康复医院诊断为STEMI并且行PCI术的437例患者。根据SHR水平分为两组:低SHR组:SHR<0.83(n=214)和高SHR组:SHR≥0.83(n=223)。SHR由以下公式确定:入院血糖/[(28.7×HbA1c%)-46.7]。主要终点是30天NOAF及3年NOAF。采用Cox回归模型分析SHR与30天NOAF和3年NOAF的相关性。绘制局部加权回归散点平滑(locally weighted scatterplot smoothing,Lowess)曲线评估SHR水平对NOAF结局的影响。同时采用受试者工作特征(ROC)曲线分析和曲线下面积(AUC)评估SHR对3年NOAF的预测效能。结果:高SHR组的患者血糖水平、hs-CRP水平、口服降糖药比例较高。多因素回归分析发现高SHR与STEMI患者的3年NOAF风险增加独立正相关(HR=2.24,95%CI:1.06~4.74,P=0.034)。Lowess曲线表明:SHR作为连续变量,与3年NOAF风险呈“J”型相关。ROC曲线表明:SHR对于3年NOAF结局具有较好的预测能力(AUC=0.711,95%CI:0.666~0.754)。结论:作为一项较易获得的实验室指标,在临床中SHR可作为STEMI患者的3年NOAF发生的预测因子。

Objective:To explore the predictive value of stress hyperglycemia ratio(SHR)for new-onset atrial fibrillation(NOAF)in patients with ST-segment elevation myocardial infarction(STEMI).Methods:This retrospective cohort study included 437 STEMI patients undergoing PCI.Patients were divided into two groups based on SHR levels:Low SHR group(SHR<0.83,n=214)and High SHR group(SHR≥0.83,n=223).SHR was calculated using the formula:In-hospital blood glucose/[(28.7×HbA1c%)-46.7].The primary endpoints were 30-day NOAF and 3-year NOAF.The Cox regression model was employed to analyze the correlation between SHR and both 30-day and 3-year NOAF.Locally weighted scatterplot smoothing(Lowess)curves were plotted to evaluate the impact of SHR levels on the NOAF outcome.Receiver operating characteristic(ROC)curve analysis and area under the curve(AUC)were used to assess the predictive efficacy of SHR for 3-year NOAF.Results:Patients in the high SHR group exhibited higher levels of blood glucose,hs-CRP,and a higher proportion of oral hypoglycemic agents.Multivariate regression analysis revealed an independent positive correlation between high SHR and a 3-year NOAF risk in STEMI patients(HR=2.24,95%CI:1.06-4.74,P=0.034).However,there was no significant correlation between high SHR and 30-day NOAF.Lowess curves indicated a"J"-shaped correlation between SHR as a continuous variable and the risk of 3-year NOAF.ROC curves demonstrated that SHR had a certain predictive capability for the 3-year NOAF outcome(AUC=0.711,95%CI:0.666-0.754).Conclusions:As a readily available laboratory indicator,SHR can serve as a predictive factor for the occurrence of 3-year NOAF in STEMI patients in clinical practice.