糖尿病患者甘油三酯葡萄糖指数和血清白蛋白表达对颈动脉斑块和主要不良心脑血管事件的预测价值

Predictive value of the triglyceride glucose index and serum albumin levels for carotid artery plaque and major adverse cardiovascular and cerebrovascular events in patients with diabetes mellitus

摘要

目的：探讨甘油三酯葡萄糖指数（TyG）和血清白蛋白表达与2型糖尿病（T2DM）和冠状动脉慢性完全闭塞（CTO）患者经皮冠状动脉介入治疗（PCI）后颈动脉斑块和主要不良心脑血管事件（MACCE）的关系。方法：本研究是一项单中心、回顾性观察队列研究。从2021年1月至2022年6月，在中国人民解放军空军第九八六医院连续招募了232名诊断为CTO并接受PCI治疗的T2DM患者。TyG指数计算为ln[甘油三酯(mg·dL^-1)×空腹血糖(mg·dL^-1)/2]。对患者进行2年随访。研究终点定义为MACCE，包括全因死亡、非致死性心肌梗死、计划外血运重建和卒中。结果：在2年的随访中，44例患者发生MACCE。与非MACCE组相比，MACCE组的血糖、TyG、颈动脉内膜⁃中膜厚度(cIMT)、C⁃反应蛋白水平显著增加（P<0.05）。Cox回归模型分析显示，年龄（HR=1.053，95%CI:1.016~1.091）、TyG（HR=2.359，95%CI:1.217~4.573）和白蛋白（HR=1.101，95%CI:1.022~1.187）是CTO和T2DM患者发生MACCE的独立影响因素（P<0.05）。TyG与C⁃反应蛋白、c⁃IMT、淋巴细胞计数呈显著正相关性（r=0.147、0.364、0.244，均P<0.05）。白蛋白与C⁃反应蛋白、WBC计数、中性粒细胞计数呈显著正相关性（r=0.187、0.147、0.162，均P<0.05）。根据TyG、白蛋白的中位数将患者分为两组，TyG较高组的MACCE累积发生风险显著高于TyG较低组（Log⁃rank=5.766，P=0.016），白蛋白较高组的MACCE累积发生风险显著高于白蛋白较低组（Log⁃rank=29.343，P<0.001）。结论：在合并T2DM和CTO患者中，TyG、白蛋白水平升高与2年随访过程中MACCE发生相关，并且TyG与c⁃IMT呈显著正相关。

Abstract

Objective: To explore the relationship between triglyceride glucose index (TyG) and serum albumin levels and carotid plaque and major adverse cardiovascular and cerebrovascular events (MACCE) after percutaneous coronary intervention (PCI) in patients with type 2 diabetes mellitus (T2DM) and chronic total coronary occlusion (CTO). Methods: This study was a single center, retrospective cohort study. From January, 2021 to June, 2022, 232 T2DM patients diagnosed as CTO and receiving PCI were recruited in PLA Air Force 986 Hospital. The TyG index was calculated as ln(triglycerides (mg·dL^-1)×fasting blood glucose (mg·dL^-1)/2). The patients were followed up for 2 years. The end point of the study was defined as MACCE, including all-cause death, nonfatal myocardial infarction, unplanned revascularization and stroke. Results: During the 2-year follow-up, 44 patients developed MACCE. Compared with those in non-MACCE group, the levels of blood sugar, TyG, cIMT and C-reactive protein in MACCE group were significantly increased (P<0.05). Cox regression model analysis showed that age (HR=1.053, 95%CI: 1.016-1.091), TyG (HR=2.359, 95%CI: 1.217-4.573), and albumin (HR=1.101, 95%CI: 1.022-1.187) were independent influencing factors of MACCE in CTO and T2DM patients (P<0.05). TyG was positively correlated with C-reactive protein, c-IMT and lymphocyte count (r=0.147, 0.364, and 0.244, all P<0.05). Albumin was positively correlated with C-reactive protein, WBC count and neutrophil count (r=0.187, 0.147 and 0.162, all P<0.05). According to the median of TyG and albumin, patients were divided into two groups. The risk of MACCE accumulation in the group with higher TyG was significantly higher than that in the group with lower TyG (Log-rank=5.766,P=0.016), and the risk of MACCE accumulation in the group with higher albumin was significantly higher than that in the group with lower albumin (Log-rank=29.343, P<0.001). Conclusion: In patients with T2DM and CTO, the elevated levels of TyG and albumin are related to the occurrence of MACCE during the 2-year follow-up, and TyG is positively correlated with c-IMT.

关键词

甘油三酯葡萄糖指数 / 血清白蛋白 / 糖尿病 / 冠状动脉慢性完全闭塞 / 主要不良心脑血管事件

Key words

Triglyceride Glucose Index / Serum Albumin / Diabetes / Chronic Total Occlusion of Coronary Artery / Major Adverse Cardiovascular and Cerebrovascular Event

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基金资助

陕西省卫生健康科研项目(2022133085)