入院时血清HDL-C和三酰甘油-葡萄糖指数与非糖尿病急性心肌梗死患者冠状动脉病变严重程度、短期预后的关系

Relationship between Serum HDL-C and Triacylglycerol-Glucose Index at Admission and the Severity of Coronary Artery Disease and Short-Term Prognosis of Non-Diabetes Mellitus Acute Myocardial Infarction Patients

目的探究入院时血清HDL-C和三酰甘油-葡萄糖(TyG)指数与非糖尿病急性心肌梗死(AMI)患者冠状动脉病变严重程度、短期预后的关系。方法回顾性选取2019—2022年芜湖市第二人民医院收治的非糖尿病AMI患者104例。收集患者的临床资料,采用Gensini积分评估患者冠状动脉病变严重程度,根据冠状动脉病变严重程度将患者分为轻度组(n=33)、中度组(n=54)、重度组(n=17)。记录患者术后半年主要不良心血管事件(MACE)发生情况,根据MACE发生情况将患者分为预后不良组(发生MACE,n=31)和预后良好组(未发生MACE,n=73)。非糖尿病AMI患者短期预后不良的影响因素分析采用多因素Logistic回归分析,采用ROC曲线分析入院时血清HDL-C、TyG指数及二者联合对非糖尿病AMI患者短期预后不良的预测价值。结果中度组患者入院时血清HDL-C低于轻度组,入院时TyG指数高于轻度组(P<0.05);重度组患者入院时HDL-C低于轻度组和中度组,入院时TyG指数高于轻度组和中度组(P<0.05)。预后不良组患者年龄大于预后良好组,合并高血压、合并高脂血症、合并外周动脉疾病、有卒中史、Killip分级Ⅲ~Ⅳ级、冠状动脉多支病变者占比及入院时空腹血糖(FPG)、血清TG、血清LDL-C、TyG指数高于预后良好组,入院时心率、左心室射血分数(LVEF)、血清HDL-C低于预后良好组(P<0.05)。多因素Logistic回归分析结果显示,Killip分级Ⅲ~Ⅳ级、冠状动脉多支病变、入院时TyG指数升高是非糖尿病AMI患者短期预后不良的危险因素,血清HDL-C升高是其保护因素(P<0.05)。ROC曲线分析结果显示,入院时血清HDL-C、TyG指数及二者联合预测非糖尿病AMI患者短期预后不良的AUC分别为0.781〔95%CI(0.676~0.885)〕、0.797〔95%CI(0.701~0.893)〕、0.882〔95%CI(0.810~0.954)〕。结论入院时血清HDL-C、TyG指数与非糖尿病AMI患者冠状动脉病变严重程度相关;入院时血清HDL-C升高是非糖尿病AMI患者短期预后不良的保护因素,入院时TyG指数升高是其危险因素,入院时血清HDL-C、TyG指数对非糖尿病AMI患者短期预后不良有一定预测价值,且二者联合的预测价值较高。

Objective To explore the relationship between serum HDL-C and triacylglycerol-glucose(TyG)index at admission and the severity of coronary artery disease and short-term prognosis of non-diabetes mellitus acute myocardial infarction(AMI)patients.Methods A total of 104 non-diabetes mellitus AMI patients admitted to the Second People's Hospital of Wuhu from 2019 to 2022 were retrospectively selected.The clinical data of patients were collected,the severity of coronary artery disease was evaluated by Gensini score,and the patients were divided into mild group(n=33),moderate group(n=54),and severe group(n=17)based on the severity of coronary artery disease.The occurrence of major adverse cardiovascular events(MACE)of patients were in half a year after operation recorded,and the patients were divide into poor prognosis group(with MACE,n=31)and good prognosis group(without MACE,n=73)based on the occurrence of MACE.Multivariate Logistic regression analysis was used to analyze the influencing factors of poor short-term prognosis of non-diabetic AMI patients.ROC curve was used to analyze the predictive value of serum HDL-C,TyG index at admission and their combination for poor short-term prognosis of nondiabetic AMI patients.Results The serum HDL-C at admission in the moderate group was lower than that in the mild group,and the TyG index at admission was higher than that in the mild group(P<0.05).The serum HDL-C at admission in the severe group was lower than that in the mild group and moderate group,and the TyG index at admission was higher than that in the mild group and moderate group(P<0.05).The age in the poor prognosis group was older than that in the good prognosis group,the proportion of patients with hypertension,hyperlipidemia,peripheral arterial disease,history of stroke,Killip grade ofⅢ-Ⅳand multi-vessel coronary disease and fasting blood glucose(FPG),serum TG,serum LDL-C and TyG index at admission were higher than those in the good prognosis group,while the heart rate,left ventricular ejection fraction(LVEF)and serum HDL-C at admission were lower than those in the good prognosis group(P<0.05).Multivariate Logistic regression analysis showed that Killip grade ofⅢ-Ⅳ,multi-vessel coronary disease,and increased TyG index at admission were risk factors for poor short-term prognosis of non-diabetes mellitus AMI patients,and increased serum HDL-C was its protective factor(P<0.05).The ROC curve analysis results showed that the AUC of serum HDL-C,TyG index at admission and their combination in predicting poor short-term prognosis of non-diabetes mellitus AMI patients were 0.781[95%CI(0.676-0.885)],0.797[95%CI(0.701-0.893)],0.882[95%CI(0.810-0.954)],respectively.Conclusion Serum HDL-C and TyG index at admission were correlated with the severity of coronary artery disease in non-diabetic AMI patients.Increased serum HDL-C at admission is a protective factor for the poor short-term prognosis in non-diabetic AMI patients,and increased TyG index at admission is its risk factor;the serum HDL-C and TyG index at admission have a certain predictive value for the poor short-term prognosis of non-diabetetes mellitus AMI patients,and the predictive value of their combination is higher.