三酰甘油葡萄糖指数与高龄失代偿性心力衰竭患者预后的相关性

Correlation between triglyceride-glucose index and prognosis in very old patients with decompensated heart failur

目的 探讨高龄失代偿性心力衰竭患者三酰甘油葡萄糖乘积(TyG)指数对预后的影响。方法 回顾性收集2020年1月至2023年12月连云港市第二人民医院老年医学科收治的≥75岁的失代偿性心力衰竭患者305例,根据TyG指数中位数将患者分为高TyG指数组(≥9.11)155例和低TyG指数组(<9.11)150例。通过连云港市第二人民医院电子病历系统收集患者实验室检查、动态血压和超声心动图检查结果,患者出院后28 d内进行电话随访。比较2组临床特征差异,用Spearman相关性分析TyG指数和患者心功能及动态血压各指标的关系,用Kaplan-Meier生存曲线分析TyG指数对患者预后的影响,用ROC曲线分析TyG指数对高龄失代偿性心力衰竭患者28 d内死亡的预测价值。结果 高TyG指数组死亡、糖尿病、高血压、空腹血糖、总胆固醇、三酰甘油、N末端B型钠尿肽前体(NT-proBNP)、室间隔厚度(IVST)、24 h收缩压变异系数、24 h舒张压变异系数高于低TyG指数组,高密度脂蛋白胆固醇(HDL-C)低于低TyG指数组(P<0.05,P<0.01)。Spearman相关性分析显示,TyG指数与IVST(r=0.526,P<0.01)、24 h收缩压变异系数(r=0.342,P<0.01)、24 h舒张压变异系数(r=0.302,P<0.01)和NT-proBNP(r=0.443,P<0.01)均呈正相关。Kaplan-Meier生存曲线分析显示,低TyG指数组28 d累积生存率显著高于高TyG指数组(94.67%vs 83.23%,log rank χ^(2)=10.436,P=0.001)。ROC曲线分析显示,TyG指数预测高龄失代偿心力衰竭患者28 d内死亡的曲线下面积为0.692(95%CI:0.597~0.786),当TyG指数截断值为9.22时,敏感性为76.50%,特异性为63.50%。结论 75岁以上老年失代偿性心力衰竭患者高TyG指数提示预后不良,TyG指数升高可能有助于识别心力衰竭高危人群。

Objective To investigate the effect of triglyceride-glucose(TyG)index on the prognosis of elderly patients with decompensated heart failure(HF).Methods Clinical data of 305patients(≥75years old)with decompensated HF admitted to our hospital from January 2020to December 2023were collected and retrospectively analyzed.According to the median TyG index,they were divided into high TyG index group(≥9.11,n=155)and low TyG index group(<9.11,n=150).The results of laboratory tests,ambulatory blood pressure monitoring(ABPM),and echocardiography(ECG)were obtained from the electronic medical record system of our hospital.All patients were followed up by telephone within 28dafter discharge.The clinical characteristics were compared between the two groups.Spearman correlation analysis was used to analyze the relationship of TyG index with cardiac function and ABPM indicators of the patients.Kaplan-Meier survival curve was plotted to analyze the influence of the TyG index on the prognosis,and ROC curve was drawn to analyze the predictive value of the TyG index for 28-day mortality in these elderly patients.Results The high TyG index group had significantly higher mortality,thicker interventricular septum thickness(IVST),larger proportions of diabetes and hypertension,and higher levels of fasting blood glucose,cholesterol,triacylglycerol,NT-proBNP and coefficients of variation(CV)in 24-h SBP and 24-h DBP,and lower HDL-C level when compared to the low TyG index group(P<0.05,P<0.01).Spearman correlation analysis revealed that the TyG index was significantly positively correlated with IVST(r=0.526,P<0.01),24-h SBP CV(r=0.342,P<0.01),24-h DBP CV(r=0.302,P<0.01)and NT-proBNP level(r=0.443,P<0.01).Furthermore,Kaplan-Meier survival analysis indicated that a significantly higher 28-day cumulative survival rate was observed in the low TyG index group than the high TyG index group(94.67%vs 83.23%,log rankχ^(2)=10.436,P=0.001).Additionally,ROC curve analysis showed that the AUC value of TyG index in predicting 28-day mortality in elderly patients with decompensated HF was 0.692(95%CI:0.597-0.786).When the cutoff value of TyG index was 9.22,the sensitivity was 76.50%,and the specificity was 63.50%.Conclusion High TyG index indicates poor prognosis in elderly patients aged over 75years with decompensated HF,and increment of TyG index may be helpful to identify high-risk HF population.