代谢综合征及各组分与急性心肌梗死患者冠状动脉病变程度及临床结局的相关性研究

王凯阳; 刘凤双; 刘永国; 李国庆; 杨毅宁; 余小林

doi:10.16766/j.cnki.issn.1674-4152.003368

代谢综合征及各组分与急性心肌梗死患者冠状动脉病变程度及临床结局的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.003368

王凯阳^{1, 2},
刘凤双^{1, 2},
刘永国^{1, 2},
李国庆^{1, 2},
杨毅宁^{1, 2},
余小林^{1, 2, ,}

1.
新疆维吾尔自治区人民医院心内科，新疆乌鲁木齐 830000
2.
新疆心脏血管稳态与再生医学研究重点实验室，新疆乌鲁木齐 830000

基金项目:

新疆维吾尔自治区自然科学基金项目 2023D01C91

详细信息

通讯作者:
余小林，E-mail：yuxiaolin288@163.com

中图分类号: R542.22 R589
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- 文章访问数: 53
- HTML全文浏览量: 13
- PDF下载量: 10
- 被引次数: 0
出版历程
- 收稿日期: 2023-07-19
- 网络出版日期: 2024-03-27

The correlation between metabolic syndrome and its components with the degree of coronary artery stenosis and clinical outcomes in patients with acute myocardial infarction

WANG Kaiyang^{1, 2},
LIU Fengshuang^{1, 2},
LIU Yongguo^{1, 2},
LI Guoqing^{1, 2},
YANG Yining^{1, 2},
YU Xiaolin^{1, 2
, ,}

1.
Department of Cardiology, Xinjiang Uygur Autonomous Region People's Hospital, Urumqi, Xinjiang 830000, China

摘要

摘要: 目的探讨代谢综合征(MS)与急性心肌梗死(AMI)患者冠状动脉病变程度及预后的相关性。方法选取2019年1月—2020年12月期间新疆维吾尔自治区人民医院心内科救治的726例AMI患者作为研究对象，Gensini评分用以定量评估冠脉病变程度，终点事件定义为主要心血管不良事件(MACEs)的发生。采用多重线性回归分析研究MS及各组分与Gensini评分的相关性；采用多因素Cox回归分析研究MACEs发生的独立危险因素。结果 MS组348例(47.9%)，非MS组378例(52.1%)。与非MS组相比，MS组年龄更大，合并高血压、糖尿病、腹型肥胖、血脂异常比例更高，腰围、收缩压、空腹血糖、血尿素氮、低密度脂蛋白胆固醇、Gensini评分水平更高，血红蛋白水平较低，氯吡格雷服用比例更高，MACEs发生率更高，差异均有统计学意义(P < 0.05)。组分内比较发现：腹型肥胖组和空腹血糖升高组的Gensini评分显著升高，差异均有统计学意义(P < 0.05)。多重线性回归分析结果显示：空腹血糖升高和腹型肥胖与Gensini评分呈独立相关。多因素Cox回归分析结果显示：糖尿病和腹型肥胖是MACEs发生的独立危险因素。结论 AMI患者合并MS十分常见，糖代谢异常和腹型肥胖与冠脉病变程度密切相关，并且明显影响患者预后。
- 代谢综合征 /
- 急性心肌梗死 /
- Gensini评分 /
- 主要心血管不良事件
Abstract: Objective To explore the correlation between metabolic syndrome (MS) with the degree of coronary artery stenosis and prognosis in patients with acute myocardial infarction (AMI). Methods There were 726 AMI patients as the subjects, from the Cardiology Department of Xinjiang Uygur Autonomous Region People's Hospital from January 2019 to December 2020. The Gensini score was used to quantitatively assess the degree of coronary artery stenosis and the clinical outcome was defined as major adverse cardiovascular events (MACEs). Multiple linear regression was used to analyze the correlation between MS and its components between Gensini score. Multivariate Cox regression was used to analyze the independent risk factors for MACEs. Results There were 348 patients (47.9%) in the MS group and 378 patients (52.1%) in the non-MS group. Compared with the non-MS group, patients in the MS group were older and had more combined hypertension, diabetes, abdominal obesity, dyslipidemia. Waist circumference, systolic blood pressure, fasting blood glucose, blood urea nitrogen, low density lipoprotein cholesterol and Gensini score were higher, hemoglobin levels were lower, clopidogrel utilization rate was higher and the incidence of MACEs was higher, the differences were statistically significant (P < 0.05). Internal comparison showed that Gensini scores were significantly increased in the group of abdominal obesity and elevated fasting blood glucose (P < 0.05). Multiple linear regression analysis results showed that elevated fasting blood glucose and abdominal obesity were independently correlated with Gensini score. Multivariate Cox regression analysis results showed that: diabetes and abdominal obesity were the independent risk factors for MACEs. Conclusion Patients with AMI complicated by MS were very common. Abnormal glucose metabolism and abdominal obesity were closely related to the degree of coronary artery stenosis, and significantly affect the prognosis of patients.
- Metabolic syndrome /
- Acute myocardial infarction /
- Gensini score /
- Major adverse cardiovascular events

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图 1 MACEs风险因素的LASSO回归筛查结果

注：A为LASSO回归的系数路径图，B为LASSO回归的交叉验证图。两条虚垂线分别为最优Lambda参数取值(Lambda.min=0.000 734 63和Lambda.1se=0.070 124 06)时，所纳入LASSO回归模型的MACEs发生的风险因素数目。

Figure 1. LASSO regression results of risk factors in MACEs

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表 1 2组AMI患者基线资料比较

Table 1. Comparison of baseline data between the two groups of AMI patients

项目	MS组(n=348)	非MS组(n=378)	统计量	P值
年龄[M(P₂₅, P₇₅), 岁]	63.0(54.0, 70.0)	58.0(49.2, 65.0)	-5.280^a	< 0.001
男性[例(%)]	247(71.0)	281(74.3)	1.032^b	0.351
高血压[例(%)]	310(89.1)	103(27.2)	282.447^b	< 0.001
糖尿病[例(%)]	239(68.7)	45(11.9)	245.221^b	< 0.001
腹型肥胖[例(%)]	209(60.1)	80(21.2)	114.388^b	< 0.001
血脂异常[例(%)]	346(99.4)	333(88.1)	38.415^b	< 0.001
吸烟史[例(%)]	118(33.9)	152(40.2)	3.082^b	0.093
冠状动脉性疾病家族史[例(%)]	59(17.0)	44(11.6)	4.202^b	0.052
腰围[M(P₂₅, P₇₅), cm]	88.0(67.4, 100.0)	72.0(62.0, 83.6)	-8.016^a	< 0.001
SBP[M(P₂₅, P₇₅), mmHg]	130(119, 143)	124(111, 136)	-3.644^a	< 0.001
DBP[M(P₂₅, P₇₅), mmHg]	78(70, 85)	75.0(70, 81)	-1.793^a	0.073
RBC[M(P₂₅, P₇₅), ×10¹²/L]	4.53(4.19, 4.90)	4.56(4.19, 4.91)	-0.389^a	0.697
WBC[M(P₂₅, P₇₅), ×10⁹/L]	7.12(5.90, 8.44)	7.04(5.80, 8.51)	-0.358^a	0.720
NE[M(P₂₅, P₇₅), %]	4.30(3.36, 5.37)	4.21(3.25, 5.58)	-0.517^a	0.605
LY[M(P₂₅, P₇₅), %]	1.93(1.52, 2.43)	1.96(1.51, 2.48)	-0.220^a	0.826
Hb[M(P₂₅, P₇₅), g/L]	137(127, 148)	140(130, 150)	-2.153^a	0.031
FBG[M(P₂₅, P₇₅), mmol/L]	6.72(5.19, 9.17)	5.37(4.63, 6.87)	-7.481^a	< 0.001
BUN[M(P₂₅, P₇₅), nmol/L]	5.70(4.69, 6.79)	5.10(4.20, 6.30)	-4.539^a	< 0.001
UA[M(P₂₅, P₇₅), nmol/L]	328(275, 396)	322(267, 389)	-0.943^a	0.346
TG[M(P₂₅, P₇₅), mmol/L]	1.65(1.19, 2.53)	1.56(1.09, 2.27)	-1.951^a	0.051
TC[M(P₂₅, P₇₅), mmol/L]	4.00(3.22, 4.79)	3.79(3.19, 4.50)	-1.775^a	0.076
HDL-C[M(P₂₅, P₇₅), mmol/L]	0.94(0.82, 1.18)	0.96(0.79, 1.13)	-1.085^a	0.278
LDL-C[M(P₂₅, P₇₅), mmol/L]	2.49(1.88, 3.13)	2.34(1.80, 2.89)	-2.107^a	0.035
TBIL[M(P₂₅, P₇₅), nmol/L]	11.50(8.48, 14.60)	11.30(8.20, 14.70)	-0.271^a	0.786
Gensini评分[M(P₂₅, P₇₅), 分]	25.0(10.8, 56.5)	20.0(6.3, 44.0)	-3.210^a	< 0.001
随访时间[M(P₂₅, P₇₅), 月]	12.4(6.8, 18.9)	13.2(7.9, 19.2)	-0.889^a	0.374
MACEs[例(%)]	81(23.3)	57(15.1)	6.236^b	0.020
阿司匹林[例(%)]	231(66.4)	256(67.7)	0.149^b	0.759
氯吡格雷[例(%)]	127(36.5)	105(27.8)	6.331^b	0.015
他汀类[例(%)]	202(58.0)	194(51.3)	3.303^b	0.081
ACEI/ARB[例(%)]	100(28.7)	82(21.7)	0.459^b	0.336
Β受体阻滞剂[例(%)]	146(42.0)	154(40.7)	0.110^b	0.798
注：^a为Z值，^b为χ²值。NE为中性粒细胞(neutrophil)，LY为淋巴细胞(lymphocyte)，UA为尿酸(uric acid)，TBIL为总胆红素(total bilirubin)，ACEI为血管紧张素转化酶抑制剂(angiotensin converting enzyme inhibitor)，ARB为血管紧张素Ⅱ受体阻滞剂(angiotensinⅡreceptor blocker)。

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表 2 MS及各组分AMI患者Gensini评分比较[M(P₂₅, P₇₅), 分]

Table 2. Comparison of Gensini scores in patients with MS and each component of AMI patients [M(P₂₅, P₇₅), points]

组别	例数	Gensini评分	Z值	P值
MS组	348	25.0(10.8, 56.5)	-3.210	0.001
非MS组	378	20.0(6.3, 44.0)
高血压组	413	22.0(10.0, 52.0)	-1.567	0.117
非高血压组	313	20.0(7.0, 48.0)
糖尿病组	284	23.5(10.0, 56.0)	-1.817	0.069
非糖尿病组	442	20.0(8.0, 44.0)
FBG正常组	384	19.5(7.0, 44.0)	-2.131	0.033
FBG升高组	342	24.0(10.0, 56.0)
腹型肥胖组	289	25.0(10.0, 57.0)	-2.656	0.008
非腹型肥胖组	437	20.0(7.0, 44.0)
HDL-C降低组	630	22.0(9.0, 49.0)	-1.718	0.086
HDL-C正常组	96	15.0(5.0, 50.0)
TG正常组	391	20.0(7.5, 52.0)	-0.095	0.924
TG升高组	335	22.0(9.5, 45.0)

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表 3 MS及其各组分与Gensini评分的线性回归分析

Table 3. Linear regression analysis between MS components and Gensini scores

变量	简单线性回归分析					多重线性回归分析
变量	B	SE	B'	t值	P值	B	SE	B'	t值	P值
MS	8.040	2.705	0.110	2.972	0.003
高血压	2.881	2.743	0.039	1.050	0.294
糖尿病	4.554	2.781	0.061	1.638	0.102
FBG升高	5.963	2.715	0.081	2.196	0.028	6.269	2.698	0.086	2.323	0.020
腹型肥胖	8.793	2.758	0.118	3.188	0.001	9.014	2.752	0.121	3.276	0.001
HDL-C降低	3.639	4.011	0.034	0.907	0.365
TG升高	2.425	2.726	0.033	0.889	0.374

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表 4 MS及其各组分与MACEs的Cox回归分析

Table 4. Cox regression analysis of MS components and MACEs

变量	单因素回归分析结果					多因素回归分析结果
变量	B	SE	Waldχ²	HR(95% CI)	P值	B	SE	Waldχ²	HR(95% CI)	P值
年龄	0.015	0.008	1.970	1.016(1.000~1.031)	0.049
MS	0.840	0.183	4.591	2.316(1.618~3.314)	< 0.001	0.070	0.251	0.280	1.073(0.656~1.756)	0.779
高血压	0.748	0.188	3.987	2.114(1.463~3.054)	< 0.001
糖尿病	0.805	0.173	4.652	2.236(1.593~3.139)	< 0.001	0.796	0.221	3.601	2.217(1.437~3.420)	< 0.001
FBG升高	0.036	0.171	0.213	1.037(0 742~1.449)	0.831
腹型肥胖	0.755	0.174	4.339	2.127(1.513~2.992)	< 0.001	0.761	0.198	3.840	2.140(1.451~3.155)	< 0.001
HDL-C降低	0.292	0.267	1.096	1.339(0.794~2.259)	0.273
TG升高	-0.114	0.173	-0.659	0.892(0.636~1.252)	0.510
Gensini评分	0.004	0.002	1.886	1.004(1.000~1.008)	0.059

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