中国内脏脂肪指数在冠心病合并代谢综合征 患者中的评估价值

Evaluation of Chinese visceral adipose index in patients with coronary heart disease combined with metabolic syndrome

目的探讨中国内脏脂肪指数(CVAI)是否可以作为冠心病合并代谢综合征人群的可靠评估指标。方法回顾性研究。连续入选2022年8月至2023年3月于江南大学附属医院心血管内科完成冠状动脉造影检查的424例冠心病患者,并分为冠心病合并代谢综合征组(220例)和冠心病未合并代谢综合征组(204例)。测量患者入院时的腰围,收集患者的一般临床资料和实验室检查结果。计算CVAI,并比较其与其他内脏肥胖指标(腰围、体质指数)对冠心病合并代谢综合征患者的评估能力。对入院后行经皮冠状动脉介入术(PCI)的286例冠心病患者进行术后12个月的主要不良心血管事件随访。结果冠心病人群总体CVAI呈正态分布,平均值为122.49±40.45。冠心病合并代谢综合征患者的体质指数、三酰甘油、空腹血糖、血尿酸、估算的肾小球滤过率(eGFR)、Gensini评分、腰围、CVAI、合并脑卒中、糖尿病和高血压比例均高于冠心病未合并代谢综合征患者,而白蛋白和高密度脂蛋白胆固醇水平均低于冠心病未合并代谢综合征患者,差异均有统计学意义(均为P<0.05)。多因素logistic回归分析显示,血尿酸(OR=1.005,95%CI:1.001~1.009,P=0.009)、eGFR(OR=1.011,95%CI:1.000~1.023,P=0.045)和CVAI(OR=1.031,95%CI:1.020~1.043,P<0.001)均是冠心病患者合并代谢综合征的危险因素,而白蛋白(OR=0.890,95%CI:0.815~0.972,P=0.010)是冠心病患者合并代谢综合征的保护因素。与腰围、体质指数和Gensini评分比较,CVAI诊断冠心病合并代谢综合征的受试者工作特征(ROC)曲线下面积(AUC)最大(AUC=0.798,95%CI:0.736~0.859),最佳诊断位点109.389,敏感度为89.1%,特异度为64.7%。Kaplan-Meier生存分析显示,冠心病患者高CVAI组(CVAI>124.41,136例)PCI术后12个月内的主要不良心血管事件发生率高于低CVAI组(CVAI≤124.41,150例)[Log-rank(Mantel-Cox),χ^(2)=4.872,P=0.027]。结论CVAI对冠心病合并代谢综合征有一定诊断价值,对PCI术后预后也有一定预测价值,可作为冠心病合并代谢综合征患者的可靠评估指标。

Objective To investigate whether the Chinese visceral adiposity index(CVAI)can serve as a reliable assessment index for people with coronary heart disease combined with metabolic syndrome.Methods A retrospective study was conducted to consecutively enroll 424 patients with coronary artery disease who completed coronary angiography in the Department of Cardiology of the Affiliated Hospital of Jiangnan University from August 2022 to March 2023.These patients were divided into two groups:coronary artery disease combined with metabolic syndrome(220 patients)and coronary artery disease without metabolic syndrome(204 patients).Waist circumference of the patients was measured on admission,and general clinical data and laboratory findings were collected.CVAI was calculated and compared with other visceral obesity indicators(waist circumference,body mass index)in its ability to assess patients with coronary heart disease combined with metabolic syndrome.The 286 patients with coronary artery disease who underwent percutaneous coronary intervention(PCI)after admission to the hospital were follo wed up for major adverse cardiovascular events 12 months after the procedure.Results The overall CVAI in the coronary heart disease population was normally distributed,with a mean of 122.49±40.45.Patients with coronary heart disease combined with metabolic syndrome had higher proportions of body mass index,triacylglycerol,fasting glucose,blood uric acid,estimated glomerular filtration rate(eGFR),Gensini score,waist circumference,CVAI,combined stroke,diabetes mellitus,and hypertension than those without metabolic syndrome,whereas had lower albumin and high-density lipoprotein cholesterol levels than those without metabolic syndrome.All differences were statistically significant(all P<0.05).Multifactorial logistic regression analysis showed that blood uric acid(OR=1.005,95%CI:1.001-1.009,P=0.009),eGFR(OR=1.011,95%CI:1.000-1.023,P=0.045)and CVAI(OR=1.031,95%CI:1.020-1.043,P<0.001)were all risk factors for combined metabolic syndrome in patients with coronary artery disease,while albumin(OR=0.890,95%CI:0.815-0.972,P=0.010)was a protective factor for combined metabolic syndrome in patients with coronary artery disease.Compared with waist circumference,body mass index and Gensini score,CVAI diagnosed combined metabolic syndrome in coronary artery disease with the largest area under the curve(AUC)of receiver operating characteristic(ROC)(AUC=0.798,95%CI:0.736-0.859),the best diagnostic locus of 109.389,with a sensitivity of 89.1%and a specificity of 64.7%.Kaplan-Meier survival analysis showed that the rate of major adverse cardiovascular events within 12 months after PCI was higher in the high CVAI group of coronary artery disease patients(CVAI>124.41,136 patients)than in the low CVAI group(CVAI≤124.41,150 patients)[Log-rank(Mantel-Cox),χ^(2)=4.872,P=0.027].Conclusions CVAI has a certain diagnostic value for coronary heart disease combined with metabolic syndrome and also shows a certain predictive value for prognosis after PCI.Moreover,it can be used as a reliable assessment index for patients with coronary heart disease combined with metabolic syndrome.