甘油三酯葡萄糖指数对急性心肌梗死患者MACE事件的预测价值

Value of triglyceride glucose index in predicting major adverse cardiovascular events in patients with acute myocardial infarction

目的:探讨甘油三酯葡萄糖指数(triglyceride glucose index,TyG指数)对急性心肌梗死患者发生主要心血管不良事件(major adverse cardiovascular events,MACE)的预测价值。方法:2013年10月至2018年10月于河北大学附属医院心血管内科就诊且行冠脉造影的急性ST段抬高型心肌梗死(st-elevation myocardial infarction,STEMI)患者1092例,依据TyG指数分为T1组(TyG指数≤9.58,533例)和T2组(TyG指数>9.58,559例)。随访4年,观察心源性死亡、非致死性心肌梗死、缺血驱动的靶血管重建术和心力衰竭再住院的发生率。另外依据MACE事件的发生与否分组,进行多因素COX分析评估MACE事件发生的危险因素。结果:在4年随访期间,T1(TyG指数≤9.58,533例)和T2组(TyG指数>9.58,559例)相比,缺血驱动的靶血管血运重建、心力衰竭再住院率、非致死性急性心肌梗死比较,差异无统计学意义(P>0.05)。相较于T1组,T2组心源性病死率更高,差异有统计学意义(χ^(2)=26.696,P<0.001)。TyG指数作为连续变量和MACE事件密切相关(HR=4.152;95%CI=1.972~8.744,P<0.001)。TyG指数(HR=4.178,95%CI=2.487~7.020,P<0.001)、性别(HR=1.802,95%CI=1.232~2.637,P=0.002)、白细胞计数(HR=1.038,95%CI=1.001~1.007,P=0.042)、肌钙蛋白Ⅰ(HR=1.027,95%CI=1.014~1.040,P<0.001)、肌酸激酶同工酶(HR=1.016,95%CI=1.007~1.024,P<0.001)、空腹血糖(HR=1.131,95%CI=1.075~1.191,P<0.001)、射血分数(HR=0.977,95%CI=0.962~0.992,P=0.003)、多支血管病变(HR=1.573,95%CI=1.303~1.898,P<0.001)、支架个数(HR=1.377,95%CI=1.072~1.769,P=0.012)为MACE事件发生的独立危险因素。结论:TyG指数对急性心肌梗死患者MACE事件有较好预测价值,TyG指数、性别、白细胞计数、肌钙蛋白Ⅰ、肌酸激酶同工酶、空腹血糖、射血分数、多支血管病变、支架个数联合预测效果更好,联合预测的特异度0.775,敏感度0.667,ROC曲线下面积为0.739。

Objective:To investigate the value of triglyceride glucose index(TyG index)in predicting major adverse cardiovascular events(MACE)events in patients with acute myocardial infarction.Methods:A total of 1092 patients with acute ST-elevation myocar-dial infarction(STEMI)who were admitted to Department of Cardiology,Affiliated Hospital of Hebei University,from October 2013 to October 2018 and underwent coronary angiography were enrolled as subjects,and according to the TyG index,they were divided into T1 group(533 patients with TyG index≤9.58)and T2 group(559 patients with TyG index>9.58).The patients were followed up for 4 years to observe the incidence rates of cardiac death,nonfatal myocardial infarction,ischemia-driven target vessel revascularization,and rehospitalization due to heart failure.In addition,the patients were divided into groups according to the presence or absence of MACE,and a multivariate Cox analysis was performed to investigate the risk factors for MACE.Results:During the 4-year follow-up,there were no significant differences between the T1 group and the T2 group in ischemia-driven target vessel revascularization,rehos-pitalization rate due to heart failure,and nonfatal acute myocardial infarction(P>0.05).Compared with the T1 group,the T2 group had a significantly higher cardiac mortality rate(χ^(2)=26.696,P<0.001).As a continuous variable,TyG index was closely associated with MACE(hazard ratio[HR]=4.152,95%CI=1.972-8.744,P<0.001),TyG index(HR=4.178,95%CI=2.487-7.020,P<0.001),sex(HR=1.802,95%CI=1.232-2.637,P=0.002),white blood cell count(HR=1.038,95%CI=1.001-1.007,P=0.042),troponinⅠ(HR=1.027,95%CI=1.014-1.040,P<0.001),creatine kinase isoenzyme(HR=1.016,95%CI=1.007-1.024,P<0.001),fasting blood glucose(HR=1.131,95%CI=1.075-1.191,P<0.001),ejection fraction(HR=0.977,95%CI=0.962-0.992,P=0.003),multi-vessel disease(HR=1.573,95%CI=1.303-1.898,P<0.001),and number of stents(HR=1.377,95%CI=1.072-1.769,P=0.012)were independent risk factors for MACE.Conclusion:TyG index has a good value in predict-ing MACE in patients with acute myocardial infarction,and the combination of TyG index,sex,white blood cell count,troponin I,cre-atine kinase isoenzyme,fasting blood glucose,ejection fraction,multi-vessel lesion,and number of stents has a better predictive effect,with a specificity of 0.775,a sensitivity of 0.667,and an area under the ROC curve of 0.739.