应激性高血糖比值与急性缺血性脑卒中患者并发主要不良心血管事件的关系

Relationship between Stress Hyperglycemia Ratio and Major Adverse Cardiovascular Events in Patients with Acute Ischemic Stroke

目的探讨应激性高血糖比值(SHR)与急性缺血性脑卒中(AIS)患者并发主要不良心血管事件(MACEs)的关系。方法回顾性选取2020年1月—2023年10月在新疆维吾尔自治区人民医院就诊的AIS患者778例为研究对象。收集患者的临床资料,根据住院期间是否发生MACEs将患者分为MACEs组(122例)和非MACEs组(656例)。采用多因素Logistic回归分析探讨AIS患者并发MACEs的影响因素;根据年龄、性别、吸烟史、饮酒史、糖尿病史、高血压史、脑卒中或短暂性脑缺血发作(TIA)史进行亚组分析;使用限制性立方样条回归分析SHR与AIS患者并发MACEs风险的剂量-反应关系。结果MACEs组年龄大于非MACEs组,空腹血糖(FBG)、高密度脂蛋白胆固醇(HDL-C)、尿素氮、血肌酐、SHR高于非MACEs组,活化部分凝血活酶时间(APTT)长于非MACEs组(P<0.05)。多因素Logistic回归分析结果显示,年龄〔OR=1.068,95%CI(1.048~1.088)〕、血肌酐〔OR=1.007,95%CI(1.001~1.013)〕、SHR〔OR=3.481,95%CI(1.542~7859)〕是AIS患者并发MACEs的独立影响因素(P<0.05)。亚组分析结果显示,SHR是年龄≥60岁、男性、无吸烟史、无饮酒史、有/无糖尿病史、有/无高血压史、无脑卒中或TIA史的AIS患者并发MACEs的影响因素(P<0.05)。限制性立方样条回归分析结果显示,SHR与AIS患者并发MACEs风险呈正向线性关系(P<0.001,P非线性=0.057)。结论SHR是年龄≥60岁、男性、无吸烟史、无饮酒史、有/无糖尿病史、有/无高血压史、无脑卒中或TIA史的AIS患者并发MACEs的影响因素;随着SHR的升高,AIS患者并发MACEs的风险逐渐升高。

Objective To investigate the relationship between stress hyperglycemia ratio(SHR)and majoRadverse cardiovasculaRevents(MACEs)in patients with acute ischemic stroke(AIS).Methods A total of 778 AIS patients admitted to People's Hospital of Xinjiang UyguRAutonomous Region from January 2020 to OctobeR2023 were retrospectively selected as the research objects.Clinical data of the patients were collected,and patients were categorized into the MACEs group(n=122)and the non-MACEs group(n=656)according to whetheRMACEs occurred during hospitalization.Multivariate Logistic regression analysis was used to explore the influencing factors of MACEs in AIS patients.Subgroup analysis was conducted according to age,sex,smoking history,drinking history,diabetes history,hypertension history,and stroke oRtransient ischemic attack(TIA)history.Restricted cubic spline analysis was used to explore the dose-response relationship between SHRand MACEs risk in AIS patients.Results The age of the MACEs group was ordeRthan that of the non-MACEs group,and fasting blood glucose(FBG),high-density lipoprotein cholesterol(HDL-C),urea nitrogen,serum creatinine,and SHRwere higheRthan those in the nonMACEs group,activated partial thromboplastin time(APTT)was longeRthan that in the non-MACEs group(P<0.05).Multivariate Logistic regression analysis showed that age[OR=1.068,95%CI(1.048-1.088)],serum creatinine[OR=1.007,95%CI(1.001-1.013)],and SHR[OR=3.481,95%CI(1.542-7.859)]were the independent influencing factors of MACEs in AIS patients(P<0.05).Subgroup analysis showed that SHRwas an influencing factoRfoRMACEs in AIS patients with aged≥60 years old,male,no smoking history,no alcohol consumption history,with/without diabetes history,with/without hypertension history,and no stroke oRTIA history(P<0.05).Restricted cubic spline analysis showed that there was a positive lineaRrelationship between SHR and the risk of MACEs in AIS patients(P<0.001,Pnonliner=0.057).Conclusion SHRis an influencing factoRof MACEs in AIS patients with aged≥60 years old,male,have no smoking history,no alcohol consumption history,with/without diabetes history,with/without hypertension history,and no stroke oRTIA history,and as SHRincreases,the risk of MACEs in AIS patients also increases.