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Article(id=1200026647085805959, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1200026645001241395, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.1045.2023.0217, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1650988800000, receivedDateStr=2022-04-27, revisedDate=null, revisedDateStr=null, acceptedDate=1657296000000, acceptedDateStr=2022-07-09, onlineDate=1764038248081, onlineDateStr=2025-11-25, pubDate=1693152000000, pubDateStr=2023-08-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1764038248081, onlineIssueDateStr=2025-11-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1764038248081, creator=13701087609, updateTime=1764038248081, updator=13701087609, issue=Issue{id=1200026645001241395, tenantId=1146029695717560320, journalId=1189873630562394117, year='2023', volume='48', issue='8', pageStart='871', pageEnd='992', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1764038247584, creator=13701087609, updateTime=1764038741950, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1200028718564474883, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1200026645001241395, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1200028718564474884, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1200026645001241395, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=944, endPage=949, ext={EN=ArticleExt(id=1200026647362630036, articleId=1200026647085805959, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Correlation between TYG and ischemic events in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To discuss the correlation between triglyceride-glucose index (TYG) and the major ischemic events in the past year in patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary interventions (PCI). Methods The present study is a retrospective analysis based on a single-center registration database. From March 2016 to March 2019, the clinical data of 2203 eligible patients with AMI undergoing primary PCI were collected from the General Hospital of Northern Theater Command, and divided into two groups according to the median TYG index at admission [TYG <9.1047 group (n=1101) and TYG ≥9.1047 group (n=1102)]. The demographic characteristics, risk factors and complication, laboratory test, operation characteristics and medication after discharge were compared between the two groups. Meanwhile, the one-year ischemic events (cardiac death, myocardial infarction and/or ischemic stroke) and all-cause death were compared between the two groups. The Cox regression models were used to analyze the correlation between TYG and main outcomes. To evaluate the predictive value of TYG for one-year ischemic events using the ROC curve. Results Compared with TYG <9.1047 group, patients in TYG ≥9.1047 group were younger, less male, and had a higher proportion of hypertension and diabetes (P<0.05), and higher incidence with significant differences (P<0.05) in the frequency of one-year ischemic events, cardiac death and all-cause death. The TYG showed acceptable performance in prediction of one-year ischemic events and all-cause death with areas under the curve (AUC) of 0.62(95%CI 0.55-0.68) for ischemic events and 0.61(95%CI 0.55-0.68) for all-cause death. The best cut-off point for distinguishing the main end point from one-year ischemic events was 9.5948, the sensitivity was 47.3%, and the specificity was 76.5%. Conclusion Excessive TYG at admission of AMI patients is significantly related to the incidence of one-year ischemic events after PCI.

, correspAuthors=Ya-Ling Han, authorNote=null, correspAuthorsNote=
E-mail:
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目的 探讨急诊行直接经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者入院时三酰甘油-葡萄糖指数(TYG)与1年主要缺血事件的相关性。方法 本研究为单中心注册登记数据库的回顾性分析。收集2016年3月-2019年3月在北部战区总医院心血管内科诊断为AMI并行急诊PCI的2203例患者的临床资料，根据入院时TYG将患者分为TYG<9.1047组(n=1101)和TYG≥9.1047组(n=1102)，分析比较两组患者的人口学特征、危险因素及并发症、实验室检查结果、手术特征、出院后用药情况，以及出院后1年内缺血事件[定义为心源性死亡、心肌梗死和(或)缺血性卒中]和全因死亡事件的发生情况，并采用Cox回归风险比例模型分析TYG与主要结局指标的相关性，采用受试者工作特征(ROC)曲线评价TYG对1年缺血事件的预测价值。结果 与TYG<9.1047组比较，TYG≥9.1047组患者的年龄偏小，男性比例较低，合并高血压、糖尿病的比例较高(P<0.05)。与TYG<9.1047组比较，TYG≥9.1047组出院后1年内的缺血事件、心源性死亡和全因死亡的发生率较高，差异有统计学意义(P<0.05)。ROC曲线分析显示，TYG对行急诊PCI的AMI患者出院后1年缺血事件和全因死亡具有良好的预测价值，曲线下面积(AUC)分别为0.62(95%CI 0.55~0.68)和0.61(95%CI 0.55~0.68)，区分主要终点1年缺血事件的最佳切点为9.5948，敏感度为47.3%，特异度为76.5%。结论 AMI患者入院时TYG过高与急诊PCI术后1年内缺血事件的增多明显相关。

, correspAuthors=韩雅玲, authorNote=null, correspAuthorsNote=
韩雅玲，E-mail：
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周鹤，医学硕士，副主任医师，主要从事冠心病介入治疗等方面的研究

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周鹤，医学硕士，副主任医师，主要从事冠心病介入治疗等方面的研究

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Dis Markers, 2019, 2019: 6891537., articleTitle=The triglyceride-glucose index predicts coronary artery disease severity and cardiovascular outcomes in patients with non-ST-segment elevation acute coronary syndrome, refAbstract=null)], funds=[Fund(id=1200026655621214943, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, awardId=BJUHFCSOARF201801-04, language=EN, fundingSource=Chinese Medical Doctor Association "Lixin Yangfan" Optimization Anti-Thrombotic Research Fund Project(BJUHFCSOARF201801-04), fundOrder=null, country=null), Fund(id=1200026655726072546, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, awardId=BJUHFCSOARF201801-04, language=CN, fundingSource=中国医师协会“立信扬帆”优化抗栓科研基金(BJUHFCSOARF201801-04), fundOrder=null, country=null), Fund(id=1200026655835124453, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, awardId=21-173-9-66, language=EN, fundingSource=Shenyang Science and Technology Plan, Research and Development in Public Health(21-173-9-66), fundOrder=null, country=null), Fund(id=1200026655960953578, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, awardId=21-173-9-66, language=CN, fundingSource=沈阳市科学技术计划(21-173-9-66), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1200026648201490878, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, xref=1, ext=[AuthorCompanyExt(id=1200026648209879485, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, companyId=1200026648201490878, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Graduate School of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning 110032, China), AuthorCompanyExt(id=1200026648218268094, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, companyId=1200026648201490878, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1辽宁中医药大学研究生院，辽宁沈阳 110032)]), AuthorCompany(id=1200026648285376965, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, xref=2, ext=[AuthorCompanyExt(id=1200026648293765573, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, companyId=1200026648285376965, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China), AuthorCompanyExt(id=1200026648297959878, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, companyId=1200026648285376965, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2北部战区总医院心血管内科，辽宁沈阳 110016)])], figs=[ArticleFig(id=1200026652693590681, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, language=EN, label=Fig.1, caption=Kaplan-Meier curves of ischemic events (A) and all-cause death (B) 1 year after discharge in two groups of AMI patients, figureFileSmall=XY/HVI8GsYjHoS/eEEoz5A==, figureFileBig=lXe9StEh5qV5D0/faQUBfw==, tableContent=null), ArticleFig(id=1200026652781671071, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, language=CN, label=图1, caption=两组AMI患者出院后1年缺血事件(A)和全因死亡(B)的Kaplan-Meier曲线

AMI. 急性心肌梗死；TYG. 三酰甘油-葡萄糖指数

, figureFileSmall=XY/HVI8GsYjHoS/eEEoz5A==, figureFileBig=lXe9StEh5qV5D0/faQUBfw==, tableContent=null), ArticleFig(id=1200026654090293930, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, language=EN, label=Fig.2, caption=Correlation between TYG and ischemic events 1 year after discharge, figureFileSmall=svhaWFkqnRZ/DpV/FuGF/Q==, figureFileBig=USNllvcMzki5MmuULzux+g==, tableContent=null), ArticleFig(id=1200026654169985713, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, language=CN, label=图2, caption=TYG与患者出院后1年缺血事件的相关性

TYG. 三酰甘油-葡萄糖指数；HR. 风险比

, figureFileSmall=svhaWFkqnRZ/DpV/FuGF/Q==, figureFileBig=USNllvcMzki5MmuULzux+g==, tableContent=null), ArticleFig(id=1200026654287426229, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, language=EN, label=Tab.1, caption=

Comparison of baseline clinical data between the two groups of AMI patients

, figureFileSmall=null, figureFileBig=null, tableContent=
项目TYG<9.1047(n=1101)TYG≥9.1047(n=1102)t/χ2P
年龄(岁, $\bar{x}±s$)61.3±11.458.2±12.06.124<0.001
男/女(例)911/190833/26917.085<0.001
高血压[例(%)]525(47.8)612(55.8)17.135<0.001
糖尿病[例(%)]115(10.5)426(38.9)238.875<0.001
陈旧性心肌梗死[例(%)]77(7.0)65(5.9)1.0610.303
脑卒中[例(%)]186(17.0)151(13.8)4.2200.040
既往PCI史[例(%)]76(6.9)79(7.2)0.0690.794
既往CABG史[例(%)]1(0.1)1(0.1)0.0001.000
外周血管疾病史[例(%)]10(0.9)4(0.4)2.5770.108
吸烟史[例(%)]7.6660.022
不吸烟321(29.2)375(34.0)
当前吸烟669(60.9)*638(58.1)*
既往吸烟108(9.8)85(7.7)
冠心病诊断[例(%)]0.0640.800
STEMI1031(93.6)1029(93.4)
NSTEMI70(6.4)73(6.6)
eGFR[ml/(min‧1.73m2), $\bar{x}±s$]86.01±21.6083.05±25.482.9470.003
TC(mmol/L, $\bar{x}±s$)4.64±0.995.23±1.26-12.055<0.001
TG(mmol/L, $\bar{x}±s$)1.01±0.352.28±1.44-28.457<0.001
HDL-C(mmol/L, $\bar{x}±s$)1.13±0.251.10±0.292.9900.003
LDL-C(mmol/L, $\bar{x}±s$)2.75±0.773.11±0.89-10.198<0.001
FPG(mmol/L, $\bar{x}±s$)7.54±2.0611.17±4.56-24.034<0.001
尿酸(μmmol/L, $\bar{x}±s$)335.95±100.47384.68±127.87-4.289<0.001
LVEF(%, $\bar{x}±s$)52.05±8.0052.26±8.63-0.5450.964
), ArticleFig(id=1200026654383895225, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, language=CN, label=表1, caption=

两组AMI患者临床基线资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目TYG<9.1047(n=1101)TYG≥9.1047(n=1102)t/χ2P
年龄(岁, $\bar{x}±s$)61.3±11.458.2±12.06.124<0.001
男/女(例)911/190833/26917.085<0.001
高血压[例(%)]525(47.8)612(55.8)17.135<0.001
糖尿病[例(%)]115(10.5)426(38.9)238.875<0.001
陈旧性心肌梗死[例(%)]77(7.0)65(5.9)1.0610.303
脑卒中[例(%)]186(17.0)151(13.8)4.2200.040
既往PCI史[例(%)]76(6.9)79(7.2)0.0690.794
既往CABG史[例(%)]1(0.1)1(0.1)0.0001.000
外周血管疾病史[例(%)]10(0.9)4(0.4)2.5770.108
吸烟史[例(%)]7.6660.022
不吸烟321(29.2)375(34.0)
当前吸烟669(60.9)*638(58.1)*
既往吸烟108(9.8)85(7.7)
冠心病诊断[例(%)]0.0640.800
STEMI1031(93.6)1029(93.4)
NSTEMI70(6.4)73(6.6)
eGFR[ml/(min‧1.73m2), $\bar{x}±s$]86.01±21.6083.05±25.482.9470.003
TC(mmol/L, $\bar{x}±s$)4.64±0.995.23±1.26-12.055<0.001
TG(mmol/L, $\bar{x}±s$)1.01±0.352.28±1.44-28.457<0.001
HDL-C(mmol/L, $\bar{x}±s$)1.13±0.251.10±0.292.9900.003
LDL-C(mmol/L, $\bar{x}±s$)2.75±0.773.11±0.89-10.198<0.001
FPG(mmol/L, $\bar{x}±s$)7.54±2.0611.17±4.56-24.034<0.001
尿酸(μmmol/L, $\bar{x}±s$)335.95±100.47384.68±127.87-4.289<0.001
LVEF(%, $\bar{x}±s$)52.05±8.0052.26±8.63-0.5450.964
), ArticleFig(id=1200026654501335744, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, language=EN, label=Tab.2, caption=

Comparison of coronary intervention data between the two groups of AMI patients

, figureFileSmall=null, figureFileBig=null, tableContent=
项目TYG<9.1047(n=1101)TYG≥9.1047(n=1102)χ2/tP
桡动脉入路[例(%)]999(90.7)981(89.0)1.7820.182
靶血管位置[例(%)]
左主干17(1.5)19(1.7)0.1110.739
前降支539(49.0)525(47.6)0.3810.537
回旋支128(11.6)116(10.5)0.6760.411
右冠状动脉439(39.9)462(41.9)0.9580.328
支架个数($\bar{x}±s$)1.03±0.611.07±0.61-1.1870.236
支架总长度(mm, $\bar{x}±s$)31.80±14.9132.90±14.90-1.5980.110
支架平均直径(mm, $\bar{x}±s$)3.09±0.703.07±0.391.0770.279
SYNTAX评分*(分, $\bar{x}±s$)16.94±9.1817.01±8.36-0.1940.846
), ArticleFig(id=1200026654606193346, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, language=CN, label=表2, caption=

两组AMI患者冠脉介入治疗资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目TYG<9.1047(n=1101)TYG≥9.1047(n=1102)χ2/tP
桡动脉入路[例(%)]999(90.7)981(89.0)1.7820.182
靶血管位置[例(%)]
左主干17(1.5)19(1.7)0.1110.739
前降支539(49.0)525(47.6)0.3810.537
回旋支128(11.6)116(10.5)0.6760.411
右冠状动脉439(39.9)462(41.9)0.9580.328
支架个数($\bar{x}±s$)1.03±0.611.07±0.61-1.1870.236
支架总长度(mm, $\bar{x}±s$)31.80±14.9132.90±14.90-1.5980.110
支架平均直径(mm, $\bar{x}±s$)3.09±0.703.07±0.391.0770.279
SYNTAX评分*(分, $\bar{x}±s$)16.94±9.1817.01±8.36-0.1940.846
), ArticleFig(id=1200026654711050948, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, language=EN, label=Tab.3, caption=

Comparison of discharge medical treatment data between the two groups of AMI patients [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
药物TYG<9.1047(n=1101)TYG≥9.1047(n=1102)χ2P
阿司匹林1033(93.8)1018(92.4)1.7940.181
P2Y12受体拮抗剂8.2820.004
氯吡格雷668(61.6)598(55.5)
替格瑞洛416(38.4)479(44.5)
他汀类药物977(88.7)946(85.8)4.1560.041
ACEI/ARB717(65.1)716(65.0)0.0050.941
β受体阻滞剂690(62.7)744(67.5)5.6860.017
), ArticleFig(id=1200026654841074377, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, language=CN, label=表3, caption=

两组AMI患者出院药物治疗资料比较[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
药物TYG<9.1047(n=1101)TYG≥9.1047(n=1102)χ2P
阿司匹林1033(93.8)1018(92.4)1.7940.181
P2Y12受体拮抗剂8.2820.004
氯吡格雷668(61.6)598(55.5)
替格瑞洛416(38.4)479(44.5)
他汀类药物977(88.7)946(85.8)4.1560.041
ACEI/ARB717(65.1)716(65.0)0.0050.941
β受体阻滞剂690(62.7)744(67.5)5.6860.017
), ArticleFig(id=1200026654987875021, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, language=EN, label=Tab.4, caption=

Comparison of end-points events between the two groups of AMI patients [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
项目TYG<9.1047(n=1101)TYG≥9.1047(n=1102)χ2P
缺血事件31(2.8)62(5.6)10.7590.001
心源性死亡19(1.7)45(4.1)10.854<0.001
MI7(0.6)21(1.3)1.3220.250
卒中6(0.5)6(0.5)0.0000.999
全因死亡27(2.5)53(4.8)8.7440.003
), ArticleFig(id=1200026655180813010, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, language=CN, label=表4, caption=

两组AMI患者终点事件发生情况比较[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
项目TYG<9.1047(n=1101)TYG≥9.1047(n=1102)χ2P
缺血事件31(2.8)62(5.6)10.7590.001
心源性死亡19(1.7)45(4.1)10.854<0.001
MI7(0.6)21(1.3)1.3220.250
卒中6(0.5)6(0.5)0.0000.999
全因死亡27(2.5)53(4.8)8.7440.003
), ArticleFig(id=1200026655336002265, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, language=EN, label=Tab.5, caption=

Correlation between TYG and occurrence of ischemic events

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3
HR(95%CI)PHR(95%CI)PHR(95%CI)P
TYG连续变量1.66(1.29~2.15)<0.0011.94(1.48~2.56)<0.0011.88(1.17~3.03)0.009
TYG二分类*
<9.59481<0.0011<0.00110.001
≥9.59482.82(1.88~4.23)3.31(2.18~5.02)3.08(1.57~6.06)
), ArticleFig(id=1200026655482802905, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1200026647085805959, language=CN, label=表5, caption=

TYG与缺血事件发生的相关性

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3
HR(95%CI)PHR(95%CI)PHR(95%CI)P
TYG连续变量1.66(1.29~2.15)<0.0011.94(1.48~2.56)<0.0011.88(1.17~3.03)0.009
TYG二分类*
<9.59481<0.0011<0.00110.001
≥9.59482.82(1.88~4.23)3.31(2.18~5.02)3.08(1.57~6.06)
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行直接PCI的急性心肌梗死患者TYG与缺血事件的相关性分析
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周鹤 1, 2 , 裘淼涵 2 , 那堃 2 , 范鹏 2 , 祁子钊 2 , 李毅 2 , 韩雅玲 2, *
解放军医学杂志 | 临床研究 2023,48(8): 944-949
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解放军医学杂志 | 临床研究 2023, 48(8): 944-949
行直接PCI的急性心肌梗死患者TYG与缺血事件的相关性分析
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周鹤1, 2, 裘淼涵2, 那堃2, 范鹏2, 祁子钊2, 李毅2, 韩雅玲2, *
作者信息
  • 1辽宁中医药大学研究生院，辽宁沈阳 110032
  • 2北部战区总医院心血管内科，辽宁沈阳 110016

    • 周鹤，医学硕士，副主任医师，主要从事冠心病介入治疗等方面的研究

通讯作者:

韩雅玲，E-mail：
Correlation between TYG and ischemic events in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention
He Zhou1, 2, Miao-Han Qiu2, Kun Na2, Peng Fan2, Zi-Zhao Qi2, Yi Li2, Ya-Ling Han2, *
Affiliations
  • 1Graduate School of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning 110032, China
  • 2Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China
出版时间: 2023-08-28 doi: 10.11855/j.issn.0577-7402.1045.2023.0217
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摘要
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目的 探讨急诊行直接经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者入院时三酰甘油-葡萄糖指数(TYG)与1年主要缺血事件的相关性。方法 本研究为单中心注册登记数据库的回顾性分析。收集2016年3月-2019年3月在北部战区总医院心血管内科诊断为AMI并行急诊PCI的2203例患者的临床资料，根据入院时TYG将患者分为TYG<9.1047组(n=1101)和TYG≥9.1047组(n=1102)，分析比较两组患者的人口学特征、危险因素及并发症、实验室检查结果、手术特征、出院后用药情况，以及出院后1年内缺血事件[定义为心源性死亡、心肌梗死和(或)缺血性卒中]和全因死亡事件的发生情况，并采用Cox回归风险比例模型分析TYG与主要结局指标的相关性，采用受试者工作特征(ROC)曲线评价TYG对1年缺血事件的预测价值。结果 与TYG<9.1047组比较，TYG≥9.1047组患者的年龄偏小，男性比例较低，合并高血压、糖尿病的比例较高(P<0.05)。与TYG<9.1047组比较，TYG≥9.1047组出院后1年内的缺血事件、心源性死亡和全因死亡的发生率较高，差异有统计学意义(P<0.05)。ROC曲线分析显示，TYG对行急诊PCI的AMI患者出院后1年缺血事件和全因死亡具有良好的预测价值，曲线下面积(AUC)分别为0.62(95%CI 0.55~0.68)和0.61(95%CI 0.55~0.68)，区分主要终点1年缺血事件的最佳切点为9.5948，敏感度为47.3%，特异度为76.5%。结论 AMI患者入院时TYG过高与急诊PCI术后1年内缺血事件的增多明显相关。

急性心肌梗死  /  冠状动脉介入治疗  /  缺血事件  /  三酰甘油-葡糖糖指数

Objective To discuss the correlation between triglyceride-glucose index (TYG) and the major ischemic events in the past year in patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary interventions (PCI). Methods The present study is a retrospective analysis based on a single-center registration database. From March 2016 to March 2019, the clinical data of 2203 eligible patients with AMI undergoing primary PCI were collected from the General Hospital of Northern Theater Command, and divided into two groups according to the median TYG index at admission [TYG <9.1047 group (n=1101) and TYG ≥9.1047 group (n=1102)]. The demographic characteristics, risk factors and complication, laboratory test, operation characteristics and medication after discharge were compared between the two groups. Meanwhile, the one-year ischemic events (cardiac death, myocardial infarction and/or ischemic stroke) and all-cause death were compared between the two groups. The Cox regression models were used to analyze the correlation between TYG and main outcomes. To evaluate the predictive value of TYG for one-year ischemic events using the ROC curve. Results Compared with TYG <9.1047 group, patients in TYG ≥9.1047 group were younger, less male, and had a higher proportion of hypertension and diabetes (P<0.05), and higher incidence with significant differences (P<0.05) in the frequency of one-year ischemic events, cardiac death and all-cause death. The TYG showed acceptable performance in prediction of one-year ischemic events and all-cause death with areas under the curve (AUC) of 0.62(95%CI 0.55-0.68) for ischemic events and 0.61(95%CI 0.55-0.68) for all-cause death. The best cut-off point for distinguishing the main end point from one-year ischemic events was 9.5948, the sensitivity was 47.3%, and the specificity was 76.5%. Conclusion Excessive TYG at admission of AMI patients is significantly related to the incidence of one-year ischemic events after PCI.

acute myocardial infarction  /  percutaneous coronary intervention  /  ischemic events  /  triglyceride-glucose index
周鹤, 裘淼涵, 那堃, 范鹏, 祁子钊, 李毅, 韩雅玲. 行直接PCI的急性心肌梗死患者TYG与缺血事件的相关性分析. 解放军医学杂志, 2023 , 48 (8) : 944 -949 . DOI: 10.11855/j.issn.0577-7402.1045.2023.0217
He Zhou, Miao-Han Qiu, Kun Na, Peng Fan, Zi-Zhao Qi, Yi Li, Ya-Ling Han. Correlation between TYG and ischemic events in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention[J]. Medical Journal of Chinese People’s Liberation Army, 2023 , 48 (8) : 944 -949 . DOI: 10.11855/j.issn.0577-7402.1045.2023.0217
正文
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虽然急性心肌梗死(acute myocardial infarction，AMI)急诊行经皮冠状动脉介入治疗(percutaneous coronary interventions，PCI)越来越普及，药物及心脏康复治疗也得到了长足发展[1]，但AMI仍然是心血管疾病的主要死亡原因，具有病死率高、预后差、花费高等特点[2]。因此，AMI患者早期开展风险评估具有良好的治疗和预防获益。胰岛素抵抗(insulin resistance，IR)是指外周组织胰岛素敏感性下降，使胰岛素的生物学效应降低，从而造成葡萄糖的摄取或氧化缺陷[3-5]。既往研究证实，IR可导致机体的炎症状态并引起血脂异常，是动脉粥样硬化性心血管疾病的重要危险因素，也是导致患者长期不良预后的危险因素[6-7]。由于检测方法耗时、昂贵、操作复杂，目前IR并未在临床广泛使用，而通过计算得到的三酰甘油-葡萄糖指数(triglyceride-glucose，TYG)已成为评估IR的“金标准”，且不受糖尿病的影响[8-9]。越来越多的研究证实，TYG与高血压、糖尿病、动脉粥样硬化明显相关，可较好地预测成人、老年人及高血压患者的糖尿病和心血管事件[10-11]。同时也有研究发现，TYG与较差的长期预后密切相关，可用于优化冠心病患者的早期危险分层[6]。近期研究发现，TYG能够预测支架内再狭窄及老年急性冠脉综合征患者的预后[12-13]。然而，在急诊行PCI的AMI患者中TYG与临床事件的相关性研究尚少。本研究探讨了TYG与AMI患者行急诊PCI后临床预后的关系，旨在为AMI患者的早期危险分层提供思路。
1 资料与方法
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1.1 研究对象
本研究为单中心注册登记数据库的回顾性分析，该注册登记数据库自2016年3月起纳入于北部战区总医院心内科住院且行PCI治疗的患者，本研究选取其中2016年3月-2019年3月诊断为AMI并行直接PCI治疗的患者2849例。AMI的诊断符合全球统一定义[14]，包括ST段抬高型AMI(ST-segment elevation myocardial infarction，STEMI)和非ST段抬高型AMI(non-ST-segment elevation myocardial infarction，NSTEMI)。纳入标准：因胸痛持续发作、心力衰竭、严重心律失常或血流动力学不稳定等需行急诊PCI治疗的AMI患者。排除标准：(1)三酰甘油(triglyceride，TG)和(或)空腹血糖(fasting plasma glucose，FPG)等临床资料缺失；(2)冠脉造影资料缺失；(3)合并全身急性或慢性炎症；(4)合并恶性肿瘤；(5)合并严重的肝、肾功能损害；(6)合并脂质代谢紊乱性疾病，如肾病综合征或甲状腺功能疾病；(7)1型糖尿病患者。最终纳入2203例患者，并根据TYG将患者按照中位数分为TYG<9.1047组(n=1101)与TYG≥9.1047组(n=1102)。本研究已获北部战区总医院伦理委员会批准[伦审(2018)35号]。
1.2 研究方法
详细记录患者的基线临床特征，包括性别、年龄、吸烟史，是否合并高血压、糖尿病、高脂血症、卒中、外周血管疾病、既往心肌梗死病史等。实验室检查指标：隔夜禁食≥12 h抽取肘静脉血，采用己糖激酶法测定FPG水平，总胆固醇(total cholesterol，TC)、TG、高密度脂蛋白胆固醇(high density liptein cholesterol，HDL-C)、低密度脂蛋白胆固醇(low density liptein cholesterol，LDL-C)使用罗氏Cobas C501全自动生化分析仪测定。估算肾小球滤过率(estimated glomerular filtration rate，eGFR)通过MDRD简化公式计算。TYG的计算公式：TYG=ln[TG(mmol/L)×88.545×FPG(mmol/L)×18.02/2]。统计两组患者出院后1年内的心血管不良事件，主要包括缺血事件复合终点[心源性死亡、心肌梗死(myocardial infarction，MI)和(或)缺血性卒中]及全因死亡事件。
1.3 指标分析
比较两组患者基线资料及1年心血管不良事件的差异，采用Cox风险比例模型分析TYG与患者出院后1年缺血事件的相关性。采用Kaplan-Meier曲线描述时序性结局事件；采用受试者工作特征(ROC)曲线分析TYG对1年缺血事件的预测价值，并探究TYG预测缺血事件的最佳切点；使用限制性立方样条图(restricted cubic splines，RCS)分析TYG与缺血事件的相关性。
1.4 统计学处理
采用R 4.1.1软件进行统计分析。符合正态分布的计量资料以$\bar{x}±s$表示，两组间比较采用独立样本t检验；计数资料以例(%)表示，组间比较采用Pearson χ2检验或Fisher精确概率法。Cox回归分析中校正的混杂因素包括人口学资料、危险因素和并发症、实验室检查结果、手术特征和用药信息。时序性结局事件的组间比较采用Log-rank检验。RCS分析中，校正的混杂因素包括人口学资料、危险因素和并发症、实验室检查结果、手术特征和用药信息。P<0.05为差异有统计学意义。
2 结果
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2.1 两组患者的临床基线特征比较
与TYG<9.1047组比较，TYG≥9.1047组患者的年龄偏小，男性比例较低，合并高血压、糖尿病的比例较高，差异均有统计学意义(P<0.001)。此外，与TYG<9.1047组比较，TYG≥9.1047组患者的eGFR、HDL-C水平降低，而TC、TG、LDL-C、FPG、尿酸水平升高，差异均有统计学意义(P<0.05)，其余指标两组比较差异无统计学意义(P>0.05)(表1)。
2.2 两组患者冠脉介入手术资料比较
两组桡动脉入路百分比、植入支架个数、支架总长度、支架平均直径比较差异均无统计学意义(P>0.05，表2)。
2.3 两组患者出院药物治疗资料比较
与TYG<9.1047组比较，TYG≥9.1047组使用P2Y12受体拮抗剂的患者中，氯吡格雷的使用率较高，替格瑞洛的使用率较低，此外，他汀类药物使用率较低，而β受体阻滞剂使用率较高，差异均有统计学意义(P<0.05，表3)。
2.4 两组终点事件发生情况比较
与TYG<9.1047组比较，TYG≥9.1047组1年的缺血事件、心源性死亡和全因死亡发生率较高，差异有统计学意义(P<0.05，表4)。Kaplan-Meier生存曲线分析显示，与TYG<9.1047组比较，TYG≥9.1047组患者的1年缺血事件和全因死亡事件发生风险明显增加，差异有统计学意义(P<0.05，图1)。
2.5 TYG对不良结局事件的预测价值
ROC曲线分析显示，TYG预测行急诊PCI的AMI患者术后1年缺血事件的曲线下面积(area under curve，AUC)为0.6173(95%CI 0.5533~0.6814，P<0.05)，界值为9.5948，敏感度为47.3%，特异度为76.5%；而预测1年全因死亡AUC为0.6125(95%CI 0.5454~0.6796，P<0.05)，界值为9.4224，敏感度为52.5%，特异度为68.9%。
2.6 TYG与缺血事件的相关性分析
采用Cox回归风险比例模型分析TYG与主要结局事件的相关性。在未校正模型1中，入院时较高的TYG与患者1年内缺血事件的发生风险增加明显相关[风险比(HR)=1.66，95%CI 1.29~2.15，P<0.001]。在校正了年龄和性别的模型2中，以及校正了人口学资料、危险因素、并发症、实验室检查结果、手术特征和用药信息的模型3中，TYG仍然是缺血事件的危险因素(HR=1.94，95%CI 1.48~2.56，P<0.001；HR=1.88，95%CI 1.17~3.03，P=0.009)。以9.5948为界值，将患者分为TYG<9.5948组(n=1640)与TYG≥9.5948组(n=563)，在模型1、2、3中，与TYG<9.5948组比较，TYG≥9.5948组患者发生缺血事件的风险分别增加至2.82倍(HR=2.82，95%CI 1.88~4.23，P<0.001)、3.31倍(HR=3.31，95%CI 2.18~5.02，P<0.001)、3.08倍(HR=3.08，95%CI 1.57~6.06，P=0.001)(表5)。使用限制性立方样条图的方法，在校正了相关混杂因素(同模型3)后，随着TYG的增加，患者缺血事件的发生风险呈上升趋势(图2)。
3 讨论
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AMI是危及国民健康的严重心血管疾病之一，China PEACE研究显示，AMI患者1年的病死率为28%，且部分患者出院后1年内可发生心肌梗死复发[15]。目前，随着血运重建技术的发展及更加有效的二级预防用药方案的应用，AMI患者得到了更加充分的救治，但整体来看其不良结局事件发生率仍居高不下。因此，寻找新的风险评价指标，以进一步评估急性AMI患者的风险具有重要意义。有研究显示，IR可通过调控葡萄糖转运至细胞中的过程而损害患者的心脏功能，在心血管疾病的发生发展中发挥着重要作用[16]，这可能与IR介导全身炎症反应、氧化应激、血管内皮功能障碍及血管重构，并加速冠状动脉粥样硬化有关。多项研究显示，IR在动脉粥样硬化性心血管疾病长期风险预测方面具有良好的价值[17]。TYG为TG与FPG的比值，可将糖脂代谢两种经典冠心病危险因素相结合，较好地反映机体的IR状态。
本研究探讨了TYG与行急诊PCI的AMI患者出院后长期临床事件的关系，结果显示，TYG≥9.1047组1年的缺血事件、心源性死亡和全因死亡发生率较TYG<9.1047组明显增高。此外，TYG被证实能够预测代谢综合征和2型糖尿病的发生风险[18]。本研究也发现，与TYG<9.1047组比较，TYG≥9.1047组合并高血压、糖尿病者更常见，且TC、TG、LDL-C、FPG及尿酸水平明显升高(P<0.05)，HDL-C水平明显降低(P<0.05)。近期研究发现，TYG与症状性的冠状动脉疾病的发病率呈正相关，可作为动脉粥样硬化的标志物[19]。在2型糖尿病患者中，较高的TYG与冠状动脉狭窄风险增加相关[20]。既往研究发现，STEMI患者的TYG与主要心脑血管不良事件的发生风险呈正相关，且可能是行急诊PCI治疗的STEMI患者临床预后的有效预测因子[21]，与本研究结果一致。同时，在NSTEMI患者中，TYG可能是动脉粥样硬化性心血管疾病严重程度和心血管结局的独立预测因子[22]。
本研究ROC曲线分析显示，TYG预测1年缺血事件的界值为9.5948，预测1年全因死亡的界值为9.4224。在既往研究中TYG在心血管疾病中的界值并无明确定论，Zhu等[12]研究中的界值为8.55，但该研究纳入的是2型糖尿病人群，而本研究中糖尿病患者仅占24.6%，因此考虑较低的血糖水平可能是本研究界值较高的原因。本研究进一步分析TYG与患者1年缺血事件的相关性，结果显示，不论校正前还是校正后，TYG均与缺血事件的发生率呈正相关。因此，TYG可作为AMI行急诊PCI患者缺血事件及全因死亡的预测指标。
但本研究也存在一定的局限性，如仅记录了患者住院期间的血糖、血脂水平，未分析既往血糖、血脂的控制情况，而住院期间影响血糖、血脂的因素较多，可能会对结果造成一定偏倚；本研究为单中心研究，样本量有限，所获结果仍需进一步通过多中心研究加以验证。
综上所述，在行急诊PCI的AMI患者中，TYG与1年缺血事件发生风险明显相关。TYG能够预测AMI患者的心血管事件，可用作危险分层和预后评估的指标。但如何根据目前的TYG界值来为患者选择最佳的调脂和降糖策略值得进一步探讨，也是未来研究的方向。
基金
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  • 中国医师协会“立信扬帆”优化抗栓科研基金(BJUHFCSOARF201801-04)
  • 沈阳市科学技术计划(21-173-9-66)
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2023年第48卷第8期
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doi: 10.11855/j.issn.0577-7402.1045.2023.0217
  • 接收时间：2022-04-27
  • 首发时间：2025-11-25
  • 出版时间：2023-08-28
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  • 收稿日期：2022-04-27
  • 录用日期：2022-07-09
基金
Chinese Medical Doctor Association "Lixin Yangfan" Optimization Anti-Thrombotic Research Fund Project(BJUHFCSOARF201801-04)
中国医师协会“立信扬帆”优化抗栓科研基金(BJUHFCSOARF201801-04)
Shenyang Science and Technology Plan, Research and Development in Public Health(21-173-9-66)
沈阳市科学技术计划(21-173-9-66)
作者信息
    1辽宁中医药大学研究生院，辽宁沈阳 110032
    2北部战区总医院心血管内科，辽宁沈阳 110016

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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