应激性高血糖比值对急性ST段抬高型心肌梗死患者院内死亡及机械性并发症的预测价值
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(遂宁市中心医院心血管内科,四川省遂宁市 629000)

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周世恒,硕士,主治医师,研究方向为冠心病,E-mail:zsh_ghost@163.com。通信作者刘益均,副主任医师,研究方向为冠心病、心律失常,E-mail:1123694551@qq.com。

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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)


The predictive value of stress hyperglycemia ratio on in-hospital mortality and mechanical complications in patients with acute ST-segment elevation myocardial infarction
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Department of Cardiovascular, Suining Central Hospital, Suining, Sichuan 629000, China)

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    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χ2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。

    Abstract:

    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=3.5,5%CI:1.719~5.538, P<0.001; Model 2:OR=2.8,5%CI:1.4439~5.132, P=0.002), cardiovascular mortality (Model 1:OR=3.6,5%CI:1.869~6.228, P<0.001; Model 2:OR=3.3,5%CI:1.595~5.817, P<0.001), ventricular aneurysm (Model 1:OR=3.3,5%CI:1.665~6.069, P<0.001; Model 2:OR=3.3,5%CI:1.785~8.663, P<0.001), cardiac rupture (Model 1:OR=2.1,5%CI:1.389~4.312, P=0.002; Model 2:OR=2.2,5%CI:1.214~4.274, P=0.009) and composite endpoint (Model 1:OR=3.9,5%CI:2.226~6.332, P<0.001; Model 2:OR=2.9,5%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 non-linearity=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.

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周世恒,谭震,刘磊,唐锴,邓学军,刘益均.应激性高血糖比值对急性ST段抬高型心肌梗死患者院内死亡及机械性并发症的预测价值[J].中国动脉硬化杂志,2025,33(5):427~434.

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  • 收稿日期:2024-10-03
  • 最后修改日期:2025-01-19
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  • 在线发布日期: 2025-06-03