应激性高血糖指数对经皮冠状动脉介入术后急性心肌梗死患者发生主要不良心脑血管事件的预测价值

Predictive effect of stress hyperglycemia ratio on major adverse cardiac and cerebrovascular events in patients with acute myocardial infarction after percutaneous coronary intervention

目的:分析应激性高血糖指数(SHR)对经皮冠状动脉介入(PCI)术后急性心肌梗死(AMI)患者发生主要不良心脑血管事件(MACCE)的预测价值。方法:选取2017年1月至2021年12月期间在临沂市人民医院进行PCI治疗的271例AMI患者,根据SHR第三个四分位数(1.59)将其分为高SHR组(SHR≥1.59,115例)和低SHR组(SHR<1.59,156例),比较两组患者的临床资料及预后情况。采用单因素及多因素logistic回归分析经PCI治疗后AMI患者发生MACCE的影响因素,受试者工作特征(ROC)曲线评估SHR对AMI患者发生MACCE的预测价值。结果:高SHR组患者的血糖、肾小球滤过率、ST段抬高型心肌梗死(STEMI)占比均显著高于低SHR组,血管重建时间和低密度脂蛋白均显著低于低SHR组(P均<0.05)。PCI治疗后第1个月、第6个月、第12个月,高SHR组MACCE发生率均显著高于低SHR组(χ^(2)=8.651、11.208、15.235,P均<0.001)。Logistic回归分析结果显示,SHR[比值比(OR)=2.231,95%置信区间(CI)(1.656,4.078),P=0.008]、血糖[OR=1.169,95%CI(1.114,1.290),P=0.002]、肾小球滤过率[OR=1.767,95%CI(1.522,2.616),P=0.041]、血管重建时间[OR=2.688,95%CI(1.704,4.145),P=0.006]、STEMI[OR=2.113,95%CI(1.269,3.381),P=0.012]均是影响MACCE发生的危险因素。SHR对AMI患者发生MACCE的预测效果最好,评估临界值为1.92,敏感度为0.782,特异度为0.830,曲线下面积为0.865,95%CI为0.772~0.962(P=0.003)。结论:SHR是评价AMI患者PCI术后MACCE发生风险的有效预测指标。

Objective:To analyze the predictive value of stress hyperglycemia ratio(SHR)for major adverse cardiac and cerebrovascular events(MACCE)in patients with acute myocardial infarction(AMI)undergoing percutaneous coronary intervention(PCI).Methods:A total of 271 AMI patients who underwent PCI in Linyi People's Hospital from January 2017 to December 2021 were selected.According to the third quartile of SHR(1.59),they were divided into a high SHR group(SHR≥1.59,115 cases)and a low SHR group(SHR<1.59,156 cases),and their clinical data and outcomes were compared between the two groups.Univariate and multivariate logistic regression methods were used to analyze the influencing factors of MACCE in AMI patients after PCI,and receiver operating characteristics(ROC)curves were used to evaluate the predictive value of SHR for MACCE.Results:Compared with the low SHR group,patients in the high SHR group showed a significant increase in blood glucose,glomerular filtration rate and ST-segment elevation myocardial infarction(STEMI)and a significant decrease in vascular reconstruction time and low densith lipoprotein(all P<0.05).The incidence of MACCE in the high SHR group was significantly increased at the 1st,6th and 12th months after PCI than that in the low SHR group(χ^(2)=8.651,11.208,15.235;all P<0.001).The logistic regression analysis showed that the SHR[odds ratio(OR)=2.231,95%confidence interval(CI)(1.656,4.078),P=0.008],blood glucose[OR=1.169,95%CI(1.114,1.290),P=0.002],glomerular filtration rate[OR=1.767,95%CI(1.522,2.616),P=0.041],vascular reconstruction time[OR=2.688,95%CI(1.704,4.145),P=0.006]and STEMI[OR=2.113,95%CI(1.269,3.381),P=0.012]were risk factors for the occurrence of MACCE in AMI patients.The ROC curve showed that the critical value for evaluating the occurrence of MACCE in AMI patients using SHR was 1.92,with the sensitivity of 0.782,specificity of 0.830,area under the curve of 0.865 and 95%CI of 0.772-0.962(P=0.003).Conclusion:SHR is an effective predictive indicator for the risk of MACCE in AMI patients undergoing PCI.