TyG、Fib与急性ST段抬高型心肌梗死患者预后的相关性-现代医学

TyG、Fib与急性ST段抬高型心肌梗死患者预后的相关性

单位：1. 昆明医科大学第二附属医院心内科, 云南昆明 650101;
2. 云南省阜外心血管病医院, 云南昆明 650000;
3. 昆明医科大学法医学院云南昆明 650500

分类号：R542.2

出版年·卷·期（页码）：2020·39·第八期（960-965）

摘要：

目的：探讨甘油三酯葡萄糖乘积指数（TyG）和纤维蛋白原（Fib）与急性ST段抬高型心肌梗死（STEMI）患者预后的相关性。方法：选取2013年9月—2015年8月我院心内科收治的发病后24 h内就诊的STEMI患者395例作为研究对象，根据患者随访期间是否发生不良心血管事件（MACE）分为MACE组（n=125）和非MACE组（n=270），分析TyG及Fib与MACE的关系。结果：与非MACE组比较，MACE组患者年龄、吸烟史比例、糖尿病比例、LDL-C、FPG、TyG、Fib更高，而左心室射血分数值（LVEF）更低（P均<0.05）；TyG、Fib诊断MACE的最佳临界值分别为8.86、2.65 g·L^-1；经校正传统危险因素后，COX多因素分析结果显示，TyG > 8.86、Fib > 2.65 g·L^-1是STEMI患者发生MACE的独立危险因素；以TyG、Fib的最佳临界值对患者进行分层结果显示，与低危险组相比，中危险组STEMI患者发生MACE的风险增加了1.82倍（95% CI=1.26~1.79，P=0.023），而高危险组患者发生MACE的风险增加了2.76倍（95% CI=2.17~9.36，P<0.001），Kaplan-Meier生存分析显示，不同组间患者无事件生存率差异存在统计学意义（P<0.001）。结论：TyG、Fib是STEMI患者发生MACE的独立预测因子，两者联用可提高STEMI患者3年MACE发生的预测效率，具有潜在临床诊断价值。

Objective: To investigate the correlation between triglyceride glucose product index (TyG) and fibrinogen (Fib) and prognosis in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods: A total of 395 STEMI patients admitted to the department of Cardiology of our hospital from September 2013 to August 2015 and treated within 24 hours after onset were selected as study subjects. According to whether adverse cardiovascular events (MACE) occurred or not during the follow-up period, the patients were divided into MACE group (n=125) and non-MACE group (n=270), and the relationship between TyG and Fib and MACE was analyzed.Results: Compared with the MACE group, MACE group had higher proportion of age, smoking history, diabetes, LDL-C, FPG, TyG and Fib, while Left ventricular ejection fraction (LVEF) was lower (P<0.05). The optimal thresholds for TyG, Fib diagnostic MACE were 8.86 and 2.65 g·L^-1, respectively after correcting the traditional risk factors, COX multivariate analysis showed TyG>8.86, FibTyG>2.65 g·L^-1 were independent risk factors for MACE. Stratified results for patients at the TyG and Fib optimal threshold showed, compared with the low-risk group, the risk of MACE STEMI patients in the middle-risk group increased by 1.82 times (95% CI=1.26~1.79, P=0.023), the risk of MACE increased 2.76 times (95% CI=2.17~9.36) in the high-risk group, P<0.001), Kaplan-Meier survival analysis showed event-free survival was statistically significant between different groups (P<0.001).Conclusion: TyG and Fib are independent predicators of MACE occurrence in STEMI patients. The combination of the two can improve the prediction efficiency of MACE occurrence in STEMI patients within 3 years, with potential clinical diagnostic value.

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