摘要
目的探讨胰岛素抵抗指数(HOMA-IR)对冠心病合并糖尿病患者介入术后不良预后的影响,并建立相关Cox预后不良风险得分模型。方法选取2015年1月至2017年6月在新疆维吾尔自治区第三人民医院就诊的111例冠心病合并糖尿病患者作为研究对象,均接受经皮冠状动脉成形介入治疗(PCI),记录患者PCI术后5年发生预后不良事件情况,重点分析HOMA-IR对冠心病合并糖尿病患者PCI术后发生预后不良事件的影响,并结合HOMA-IR建立预测患者PCI术后发生预后不良事件的Cox预后不良风险得分模型。结果单因素Cox回归分析显示,多支病变、空腹血糖、HOMA-IR、C反应蛋白、冠心病类型以及SYNTAX积分在单因素分析中具有统计学意义(P<0.05),多因素Cox回归分析显示,HOMA-IR、C反应蛋白、冠心病类型以及SYNTAX积分为冠心病合并糖尿病患者PCI术后发生预后不良事件的独立预测因素(P<0.05),其中HOMA-IR每增加1个单位,患者PCI术后发生预后不良事件风险增加1.684倍(HR=2.684,95%CI 1.254~3.798,P=0.009),相关性分析显示,空腹血糖、糖化血红蛋白、多指病变、SYNTAX积分以及C反应蛋白与HOMA-IR呈正相关(P<0.05),Cox预后不良风险得分的最佳诊断截点为0.07,并根据最佳诊断截点将患者分为高危组和低危组,高危组患者PCI术后发生预后不良事件风险较高,而低危组正好相反,HOMA-IR自左向右呈现由低表达向高表达的趋势,与患者的预后不良风险得分呈正相关。结论HOMA-IR、C反应蛋白、冠心病类型以及SYNTAX积分为冠心病合并糖尿病患者PCI术后发生预后不良事件的独立预测因素,结合4个独立预测因素建立的Cox预后不良风险得分模型具有较高的预测价值。
Objective To investigate the effect of insulin resistance index(HOMA-IR)on the poor prognosis of the patients with coronary heart disease complicated with diabetes after percutaneous coronary intervention and to establish a Cox risk score model for poor prognosis.Methods A totle of 111 patients with coronary heart disease complicated with diabetes who were treated in the Third People’s Hospital of Xinjiang Uygur Autonomous Region from January 2015 to June 2017 were selected as the research objects.All of them received percutaneous coronary intervention(PCI).The adverse events of prognosis in 5 years after PCI were recorded.The impact of HOMA-IR on the adverse events of prognosis in the patients with coronary heart disease complicated with diabetes after PCI was analyzed,Combined with HOMA-IR,a Cox model for predicting adverse prognostic events after PCI was established.Results Univariate Cox regression analysis showed that multiple vessel disease,fasting blood glucose,HOMA-IR,C-reactive protein,coronary heart disease type and SYNTAX score were statistically significant in univariate analysis(P<0.05).Multivariate Cox regression analysis showed that HOMA-IR,C-reactive protein,coronary heart disease type and SYNTAX score were the independent predictors of adverse events after PCI in the patients with coronary heart disease and diabetes(P<0.05);and for each additional unit of HOMA-IR,the risk of adverse events after PCI increased by 1.684 times(HR=2.684,95%CI 1.254~3.798,P=0.009).Correlation analysis showed that fasting blood glucose,glycosylated hemoglobin,polydactyly,SYNTAX score and C-reactive protein were positively correlated with HOMA-IR(P<0.05).The patients were divided into the high-risk group and low-risk group according to the best diagnostic cut-off point.The high-risk group had a higher risk of adverse prognostic events after PCI,while the low-risk group was just the opposite.HOMA-IR showed a trend from low expression to high expression from left to right,which was positively correlated with the risk sc
作者
依力努尔·赛买提
潘颖
Yilinuer SAIMAITI;PAN Ying(Cardiovascular Department,the Third People’s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830046,China;Endocrine Nephrology Department,the Third People’s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830046,China)
出处
《中国心血管病研究》
CAS
2023年第2期155-159,共5页
Chinese Journal of Cardiovascular Research
基金
新疆维吾尔自治区自然科学基金(2019D01C192)。
关键词
胰岛素抵抗指数
冠心病
糖尿病
不良预后
Insulin resistance index
Coronary heart disease
Diabetes
Poor prognosis
