摘要
[目的]评估应激性高血糖比值(SHR)对急性ST段抬高型心肌梗死(STEMI)患者院内死亡及机械性并发症的预测价值。[方法]本研究是一项回顾性研究,收集2019年6月—2023年7月期间在遂宁市中心医院诊断为急性STEMI患者995例。基线资料比较采用t检验或Mann-Whitney U检验及χ^(2)检验;采用Logistic回归分析探讨SHR与急性STEMI患者院内死亡和机械性并发症风险的关系;采用基于Logistic回归模型的限制性立方条样分析探讨SHR与院内死亡和机械性并发症风险是否存在非线性关系;采用ROC曲线评估SHR的诊断效能;亚组分析评估SHR在各个亚组中的预测效能。[结果]高SHR患者心血管死亡率显著升高(P=0.007)。高SHR是急性STEMI患者院内全因死亡(模型1:OR=3.085,95%CI:1.719~5.538,P<0.001;模型2:OR=2.738,95%CI:1.4439~5.132,P=0.002)、心血管死亡(模型1:OR=3.406,95%CI:1.869~6.228,P<0.001;模型2:OR=3.053,95%CI:1.595~5.817,P<0.001)、室壁瘤形成(模型1:OR=3.203,95%CI:1.665~6.069,P<0.001;模型2:OR=3.93,95%CI:1.785~8.663,P<0.001)、心脏破裂(模型1:OR=2.461,95%CI:1.389~4.312,P=0.002;模型2:OR=2.302,95%CI:1.214~4.274,P=0.009)及复合终点(模型1:OR=3.719,95%CI:2.226~6.332,P<0.001;模型2:OR=2.919,95%CI:1.576~5.405,P<0.001)的独立危险因素。SHR水平与院内全因死亡(非线性P=0.250)、心血管死亡(非线性P=0.129)、室壁瘤形成(非线性P=0.588)、心脏破裂(非线性P=0.787)及复合终点(非线性P=0.399)的发生风险呈正相关线性关系;SHR对院内全因死亡(AUC=0.694)、心血管死亡(AUC=0.697)、室壁瘤形成(AUC=0.706)、心脏破裂(AUC=0.667)及复合终点(AUC=0.730)的诊断效能较好,且SHR在各亚组中的预测效能稳定。[结论]高SHR是急性STEMI患者出现院内死亡及心脏机械性并发症的独立危险因素,SHR对急性STEMI患者的预后具有重要的预测价值。
Aim To explore the predictive value of stress hyperglycemia ratio(SHR)for in-hospital mortality and mechanical complications in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods This study constituted a retrospective investigation that collected 995 patients diagnosed with acute STEMI at Suining Central Hospital from June 2019 to July 2023.Comparisons of baseline data were conducted using t-test,Mann-Whitney U test and chi-square test;Logistic regression was used to analyze the association between SHR and the risk of in-hospital mortality and mechanical complications in acute STEMI patients;Restricted cubic spline analysis based on the Logistic regression model was utilized to explore non-linear relationship between SHR and the risk of in-hospital mortality and mechanical complications;ROC curve was used to evaluate the diagnostic efficacy of SHR;Subgroup analysis was used to assess the predictive efficacy of SHR in each subgroup.Results Patients with high SHR had a significantly higher cardiovascular mortality(P=0.007).High SHR was an independent risk factor for in-hospital all-cause mortality(Model 1:OR=3.085,95%CI:1.719~5.538,P<0.001;Model 2:OR=2.738,95%CI:1.4439~5.132,P=0.002),cardiovascular mortality(Model 1:OR=3.406,95%CI:1.869~6.228,P<0.001;Model 2:OR=3.053,95%CI:1.595~5.817,P<0.001),ventricular aneurysm(Model 1:OR=3.203,95%CI:1.665~6.069,P<0.001;Model 2:OR=3.93,95%CI:1.785~8.663,P<0.001),cardiac rupture(Model 1:OR=2.461,95%CI:1.389~4.312,P=0.002;Model 2:OR=2.302,95%CI:1.214~4.274,P=0.009)and composite endpoint(Model 1:OR=3.719,95%CI:2.226~6.332,P<0.001;Model 2:OR=2.919,95%CI:1.576~5.405,P<0.001)in patients with acute STEMI.SHR was positively correlated in a linear relationship with the risk of in-hospital all-cause mortality(P for nonlinearity=0.250),cardiovascular mortality(P for non-linearity=0.129),ventricular aneurysm(P for non-linearity=0.588),cardiac rupture(P for non-linearity=0.787)and composite endpoint(P for non-linearity=0.399).The SHR had excellent diagnostic efficacy for in-hospital all-cause mortality(AUC=0.694),cardiovascular mortality(AUC=0.697),ventricular aneurysm(AUC=0.706),cardiac rupture(AUC=0.667)and composite endpoint(AUC=0.730),meanwhile SHR predicted efficacy consistently across subgroups.Conclusions High SHR is an independent risk factor for in-hospital all-cause mortality,cardiovascular mortality and cardiac mechanical complications in patients with acute STEMI.SHR holds significant predictive value for the prognosis of patients with STEMI.
作者
周世恒
谭震
刘磊
唐锴
邓学军
刘益均
ZHOU Shiheng;TAN Zhen;LIU Lei;TANG Kai;DENG Xuejun;LIU Yijun(Department of Cardiovascular,Suining Central Hospital,Suining,Sichuan 629000,China)
出处
《中国动脉硬化杂志》
2025年第5期427-434,共8页
Chinese Journal of Arteriosclerosis
基金
遂宁市中医药科研专项课题(SN2022B03)
四川省基层卫生事业发展研究中心项目(SWF-Z20-Q-058)。
关键词
应激性高血糖比值
急性ST段抬高型心肌梗死
机械性并发症
院内死亡
stress hyperglycemia ratio
acute ST-segment elevation myocardial infarction
mechanical complications
in-hospital mortality
