应激性高血糖比值对围产期心肌病患者预后的预测价值

Predictive value of stress hyperglycemia ratio for the prognosis of patients with peripartum cardiomyopathy

目的探讨应激性高血糖比值(SHR)对围产期心肌病(PPCM)患者预后的预测价值。方法连续性收集2007年1月至2023年3月于首都医科大学附属北京安贞医院住院治疗诊断为PPCM的78例患者的临床资料进行回顾性分析。根据心功能是否改善分为无改善组(37例)和改善组(41例)。使用受试者工作特征(ROC)曲线分析SHR对患者不良预后的预测效能,采用Logistic回归分析方法评估心功能无改善的影响因素。结果无改善组患者年龄、经产妇比例、PPCM病史比例、左心室舒张末期内径、血肌酐、血糖、B型脑钠肽水平、SHR均大于/高于改善组,收缩压、左心室射血分数(LVEF)均低于改善组(均P<0.05)。ROC曲线分析结果显示,SHR预测PPCM患者出现不良预后的最佳截断值为1.079,敏感度为81.1%,特异度为90.2%,曲线下面积为0.880(95%置信区间:0.800~0.961)(P=0.041)。多因素Logistic回归分析结果显示SHR≥1.079、血肌酐及LVEF<35%为PPCM患者不良预后的独立危险因素(均P<0.05)。结论SHR≥1.079是PPCM患者预后不良的危险因素,使用SHR可以协助识别PPCM高危人群。

Objective To investigate the prognostic value of stress hyperglycemia ratio(SHR)in patients with peripartum cardiomyopathy(PPCM).Methods The clinical data of 78 patients diagnosed with PPCM in Beijing Anzhen Hospital,Capital Medical University from January 2007 to March 2023 were collected and retrospectively analyzed.According to the improvement of cardiac function,the patients were divided into non-improvement group(37 cases)and improvement group(41 cases).The receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of SHR for poor prognosis of patients,and Logistic regression analysis was used to evaluate the influencing factors of no improvement of cardiac function.Results The age,proportion of multipara,proportion of PPCM history,left ventricular end diastolic diameter,serum creatinine,blood glucose,B-type natriuretic peptide and SHR in the non-improvement group were larger/higher than those in the improvement group,while systolic blood pressure and left ventricular ejection fraction(LVEF)were lower than those in the improvement group(all P<0.05).The ROC curve analysis results showed that the optimal cut-off value of SHR for predicting poor prognosis in patients with PPCM was 1.079,the sensitivity was 81.1%,the specificity was 90.2%,and the area under the curve was 0.880(95%confidence interval:0.800-0.961)(P=0.041).Multivariate Logistic regression analysis results showed that SHR≥1.079,serum creatinine and LVEF<35%were independent risk factors for poor prognosis in patients with PPCM(all P<0.05).Conclusion SHR≥1.079 is a risk factor for poor prognosis in PPCM patients,and the use of SHR can assist in identifying high-risk populations for PPCM.