摘要
目的探讨预后营养指数(PNI)对冠心病合并2型糖尿病患者近期主要不良心血管事件(MACE)的评估价值。方法收集2022年1月—2023年1月河北省人民医院心血管内科住院的391例冠心病合并2型糖尿病患者的临床资料进行回顾性分析,随访1年,根据有无MACE发生分为MACE组(n=99)与非MACE组(n=292),比较两组基线资料,采用单因素和多因素Cox回归分析探索冠心病合并2型糖尿病患者近期发生MACE的影响因素。绘制受试者操作特征曲线分析PNI对近期MACE发生的预测价值,并计算曲线下面积。绘制PNI与冠心病合并2型糖尿病患者MACE发生风险相关性的限制性立方样条模型。绘制Kaplan-Meier曲线探索PNI对近期MACE发生的风险。采用Spearman秩相关系数法分析PNI与心血管疾病危险因素的相关性。结果多因素Cox回归分析显示,PNI、空腹血糖、糖化血红蛋白、血小板/淋巴细胞比值、脂蛋白(a)是冠心病合并2型糖尿病患者发生MACE的独立影响因素(P<0.05),PNI预测冠心病合并2型糖尿病患者近期发生MACE的曲线下面积为0.755(95%CI 0.698~0.811),限制性立方样条模型显示,PNI与MACE发生风险呈线性负相关(P_(非线性)=0.800)。此外,PNI与MACE的相关性在不同亚组中一致。相关性分析显示,PNI与体重指数、左室射血分数、估算肾小球滤过率、淋巴细胞计数呈正相关(P<0.05);PNI与年龄、D-二聚体、脂蛋白(a)、血小板/淋巴细胞比值、中性粒细胞/淋巴细胞比值呈负相关(P<0.05);Kaplan-Meier生存曲线显示,高PNI组发生MACE风险低于低PNI组,存在统计学差异(Waldχ^(2)=25.666,P_(Log Rank)<0.001)。结论PNI是冠心病合并2型糖尿病患者近期发生MACE的独立影响因素,对临床工作者早期预防冠心病合并2型糖尿病患者MACE的发生具有一定的指导意义。
Objective To explore the value of prognostic nutritional index(PNI)in assessing recent major adverse cardiovascular events(MACE)in patients with coronary heart disease(CHD)combined with type 2 diabetes mellitus(T2DM).Methods The clinical data of 391 patients with CHD combined with T2DM who were hospitalized in the Department of Cardiovascular Medicine of Hebei Provincial People’s Hospital from January 2022 to January 2023 were collected for retrospective analysis,followed up for 1 year,and divided into the MACE group(n=99)and the non-MACE group(n=292)according to the presence or absence of the occurrence of MACE,and the general data of the two groups were compared,and the one-way and multifactorial Cox regression analyses were used to explore the factors influencing the recent occurrence of MACE in patients with CHD combined with T2DM.The predictive value of PNI on the occurrence of recent MACE was analysed by plotting the receiver operating characteristic curve and calculating the area under the curve(AUC).Restricted cubic spline(RCS)of the sub-risk correlation between PNI and MACE occurrence in patients with CHD combined with T2DM was plotted.Kaplan-Meier curves were plotted to explore the risk of PNI on the occurrence of recent MACE.Spearman rank correlation was used to analyse the association between PNI and cardiovascular disease risk factors.Results The multifactorial Cox regression analysis found that PNI,fasting blood glucose,glycosylated hemoglobin,platelet to lymphocyte ratio and lipoprotein(a)were independent influencing factors for the occurrence of MACE in patients with CHD combined with T2DM(P<0.05),and the AUC of PNI for predicting the recent occurrence of MACE in patients with CHD combined with T2DM was 0.755(95%CI 0.698~0.811),and RCS showed that PNI was linearly and negatively associated with the risk of developing MACE(P_(nonlinear)=0.800).Furthermore,the correlation between PNI and MACE was consistent across subgroups.Correlation analysis showed that PNI was positively correlated with body mass index,left ventricular ejection fraction,estimated glomerular filtration rate and lymphocyte count(P<0.05);PNI was negatively correlated with age,D-dimer,lipoprotein(a),platelet to lymphocyte ratio and neutrophil to lymphocyte ratio(P<0.05);and Kaplan-Meier survival curves showed that the risk of developing MACE in the high-PNI group was lower than that of the low PNI group,which was statistically different(Waldχ^(2)=25.666,P_(Log Rank)<0.001).Conclusion PNI is an independent factors affecting the recent occurrence of MACE in patients with CHD combined with T2DM and is clinically relevant in identifying the occurrence of MACE in this group of patients.
作者
陈坤
王贤
安慧
齐鹏
谷剑
陈淑霞
CHEN Kun;WANG Xian;AN Hui;QI Peng;GU Jian;CHEN Shuxia(Graduate School of Hebei North College,Zhangjiakou 075000,Hebei,China;Department of Cardiovascular Medicine,Hebei Provincial People’s Hospital,Shijiazhuang 050051,Hebei,China)
出处
《心血管病学进展》
2025年第1期77-85,共9页
Advances in Cardiovascular Diseases
基金
河北省重点研发计划项目(22377783D)。
关键词
冠心病
2型糖尿病
预后营养指数
主要不良心血管事件
评估价值
Coronary heart disease
Type 2 diabetes mellitus
Prognostic nutritional index
Major adverse cardiovascular events
Assessment value
