慢性心力衰竭患者三酰甘油葡萄糖指数与心房颤动发生的相关性研究

Correlation between Triglyceride Glucose Index and Atrial Fibrillation in Patients with Chronic Heart Failure

背景胰岛素抵抗(IR)与心房颤动(AF)及心房重构有关,三酰甘油葡萄糖(TyG)指数作为IR新型简单且有价值的指标与慢性心力衰竭(CHF)患者发生AF相关性的研究甚少。目的探讨CHF患者TyG指数与AF发生风险的相关性。方法回顾性选取2021年1月—2022年1月在郑州大学第二附属医院心血管内科住院的CHF患者417例为研究对象,根据CHF患者是否发生AF将其分为两组:AF组(138例)和非AF组(279例)。依据四分位数将TyG指数分为4个水平:Q1(TyG指数≤8.20)、Q2(8.20<TyG指数≤8.44)、Q3(8.44<TyG指数≤8.84)、Q4(TyG指数>8.84)。通过医院电子病历系统收集患者基线资料,包括TyG指数及基本资料、实验室检查指标、超声心动图资料等。利用LASSO回归分析进行变量筛选,采用多因素Logistic回归分析探讨CHF患者TyG指数与AF发生风险的相关性,并构建回归模型。同时采用受试者工作特征曲线分析TyG指数对CHF患者发生AF的预测价值。绘制TyG指数与CHF患者AF发生风险相关性的限制性立方样条图。结果AF组患者BMI,美国纽约心脏病学会心功能分级Ⅲ~Ⅳ级、高血压比例,血尿酸(SUA)、三酰甘油、血尿素氮(BUN)、空腹血糖、N末端B型钠尿肽前体、TyG指数、左心房内径(LAD),β受体阻滞剂、钙拮抗剂、利尿剂使用比例高于非AF组,而总胆固醇(TC)、内生肌酐清除率(Ccr)、左心室射血分数,血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)类药物使用比例低于非AF组(P<0.05)。多因素Logistic回归分析结果显示,合并高血压(OR=1.749,95%CI=1.048~2.918,P=0.032)、BUN升高(OR=1.269,95%CI=1.104~1.457,P=0.001)、SUA升高(OR=1.002,95%CI=1.000~1.005,P=0.047)、TyG指数升高(OR=2.360,95%CI=1.397~3.987,P=0.001)、LAD升高(OR=1.065,95%CI=1.034~1.097,P<0.001)、使用利尿剂(OR=4.019,95%CI=2.140~7.548,P<0.001)是CHF患者发生AF的危险因素;Ccr升高(OR=0.985,95%CI=0.975~0.996,P=0.006)、TC升高(OR=0.587,95%CI=0.445~0.775,P<0.001)、使用ACEI/ARB类药物(OR=0.427,95%CI=0.253~0.718,P=0.001)是CHF患者发生AF的保护因素。充分调整混杂因素后,与Q1水平相比,TyG指数Q2、Q3、Q4水平CHF患者AF发生风险分别是Q1水平的1.902倍、2.060倍和2.841倍(P<0.05)。限制性立方样条分析显示,TyG指数与AF发生风险呈线性正相关(P_(非线性)=0.494)。TyG指数及LASSO-Logistic回归模型预测CHF患者发生AF的曲线下面积分别为0.661(95%CI=0.608~0.724,P<0.001)、0.843(95%CI=0.803~0.882,P<0.001)。TyG指数与AF的相关性在不同亚组中一致。结论在CHF患者中,TyG指数与AF发生独立相关,且在识别该类患者AF的发生中具有一定的临床价值。

Background Insulin resistance(IR)is associated with atrial fibrillation(AF)and atrial remodeling,and the correlation of triacylglycerol glucose(TyG)index,a novel,simple,and valuable indicator of IR,with the development of AF in patients with chronic heart failure(CHF)has been poorly studied.Objective To investigate the correlation between TyG index and AF in patients with CHF.Methods A total of 417 CHF patients hospitalized in the Department of Cardiovascular Medicine of the Second Affiliated Hospital of Zhengzhou University from January 2021 to January 2022 were retrospectively selected for the study,and the CHF patients were divided into two groups according to whether they developed AF:the AF group(138 patients)and the non-AF group(279 patients).The TyG index was categorized into four levels based on quartiles:Q1(TyG index≤8.20),Q2(8.20<TyG index≤8.44),Q3(8.44<TyG index≤8.84),and Q4(TyG index>8.84).Patients'baseline data,including TyG index and basic information,laboratory test indexes,and echocardiographic data,were collected through the hospital's electronic medical record system.The LASSO regression algorithm was used for variable screening,and multivariate Logistic regression was used to analyze the correlation between TyG index and the risk of AF occurrence in patients with CHF and to construct a regression model.The predictive value of TyG index for the occurrence of AF in CHF patients was also analyzed using the subject work characteristics curve.Restricted cubic spline plots of the correlation between TyG index and the risk of developing AF in CHF patients were plotted.Results Patients in the AF group had higher BMI,New York Heart Association cardiac function classⅢ-Ⅳ,proportion of hypertension,serum uric acid(SUA),triacylglycerol,blood urea nitrogen(BUN),fasting blood glucose,N-terminal B-type natriuretic peptide precursor,TyG index,left atrial diameter(LAD),the proportions ofβ-blockers,calcium antagonists,and diuretics were higher than those in the non-AF group;total cholesterol(TC),endogenous creatinine clearance(Ccr),left ventricular ejection fraction,and the proportion of angiotensin-converting enzyme inhibitors/angiotensinⅡreceptor blockers(ACEI/ARB)class of drug use was lower than that of the non-AF group(P<0.05).The results of multivariate Logistic regression analysis showed that the combination of hypertension(OR=1.749,95%CI=1.048-2.918,P=0.032),elevated BUN(OR=1.269,95%CI=1.104-1.457,P=0.001),elevated SUA(OR=1.002,95%CI=1.000-1.005,P=0.047),elevated TyG index(OR=2.360,95%CI=1.397-3.987,P=0.001),elevated LAD(OR=1.065,95%CI=1.034-1.097,P<0.001),and use of diuretics(OR=4.019,95%CI=2.140-7.548,P<0.001)were risk factors for the development of AF in patients with CHF;Ccr(OR=0.985,95%CI=0.975-0.996,P=0.006),TC(OR=0.587,95%CI=0.445-0.775,P<0.001),and the proportion of ACEI/ARB class of drug(OR=0.427,95%CI=0.253-0.718,P=0.001)were protective factors for the development of AF in patients with CHF.After fully adjusting for confounders,the risk of AF occurrence in CHF patients at the Q2,Q3,and Q4 levels of TyG index was 1.902,2.060,and 2.841 times higher than that at the Q1 level(P<0.05).Restricted cubic spline analysis showed a linear positive correlation between TyG index and the risk of developing AF(P_(nonlinear)=0.494).The area under the curve of TyG index and LASSO-Logistic regression model for predicting the development of AF in patients with CHF were 0.661(95%CI=0.608-0.724,P<0.001),0.843(95%CI=0.803-0.882,P<0.001).In addition,the correlation between TyG index and AF was consistent across subgroups.Conclusion The TyG index is independently associated with the AF in patients with CHF,with significant clinical value in predicting AF.