应激性高血糖比值对急性心肌梗死患者PCI术后左心室重塑的预测价值

The predictive value of stress hyperglycemia ratio for left ventricular remodeling after PCI in patients with acute myocardial infarction

摘要:

目的]探讨应激性高血糖比值(SHR)与急性心肌梗死患者经皮冠状动脉介入治疗(PCI)术后左心室重塑的关系。 [方法]回顾性分析自2016年1月至2023年12月在首都医科大学宣武医院心内科住院接受PCI术且具备完整超声心动图随访资料的1 160例急性心肌梗死患者,根据是否发生左心室重塑分为重塑组(n＝262)与非重塑组(n＝898),比较两组患者SHR的差异；进一步将SHR按三分位数分组,分析不同水平SHR与左心室重塑的关系；运用多因素Logistic回归分析,评估SHR与左心室重塑的独立相关性。 [结果]重塑组SHR显著高于非重塑组(P＝0.023)。按SHR三分位数分组分析显示,高SHR组左心室重塑的发生率显著高于低SHR组(27.9%比17.8%,P＝0.003)。多因素Logistic回归分析显示,在调整混杂因素后,SHR仍是左心室重塑的独立危险因素(OR＝1.53,95%CI:1.01～2.29,P＝0.043)。ROC曲线分析显示,SHR预测左心室重塑的曲线下面积为0.57(95%CI:0.52～0.63),最佳截断值为0.88。另外,SHR在各亚组中的表现稳定。 [结论]SHR与急性心肌梗死患者PCI术后左心室重塑的发生呈正相关关系,是预测左心室重塑的独立危险因素。

Abstract:

Aim To investigate the relationship between stress hyperglycemia ratio (SHR) and left ventricular remodeling after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction. Methods A retrospective analysis was conducted on 1 160 patients with acute myocardial infarction who underwent PCI and had complete echocardiographic follow-up data in the Cardiology Department of Xuanwu Hospital, Capital Medical University from January 2016 to December 2023. The patients were divided into the remodeling group (n＝262) and the non-remodeling group (n＝898) according to the presence or absence of left ventricular remodeling, and the differences in SHR between the two groups were compared. Furthermore, the SHR were grouped into tertiles to analyze the relationship between different levels of SHR and left ventricular remodeling. Multivariable Logistic regression was used to analyze the independent correlation between SHR and left ventricular remodeling. Results The SHR was significantly higher in the remodeling group than that in the non-remodeling group (P＝0.023). Tertile analysis of SHR showed that the incidence of left ventricular remodeling in the high SHR group was significantly higher than that in the low SHR group (27.9% vs. 17.8%, P＝0.003). Multivariable Logistic regression analysis showed that SHR remained an independent risk factor for left ventricular remodeling after adjusting for confounders (OR＝1.3,5%CI:1.01～2.29, P＝0.043). ROC curve analysis showed that the area under the curve for predicting left ventricular remodeling in SHR was 0.57 (95%CI:0.52～0.63), with an optimal cutoff value of 0.88. Additionally, the performance of SHR remained stable across all subgroups. Conclusion SHR is positively correlated with the occurrence of left ventricular remodeling after PCI in patients with acute myocardial infarction, and is an independent risk factor for predicting left ventricular remodeling.