查看更多>>摘要：目的 探讨急性慢性血糖比值对急性心力衰竭（AHF）患者出院后易损期不良预后的评估价值。 方法 回顾性收集2019年5月至2022年5月在南京市浦口区中医院治疗的98例AHF患者的临床资料，随访3个月，按照出院后易损期是否发生不良事件分为不良预后组（31例）和非不良预后组（67例）。根据入院时静脉血糖和糖化血红蛋白（HbA1c）计算急性慢性血糖比值。采用Cox风险比例模型分析影响AHF患者易损期不良预后的因素，采用受试者工作特征（ROC）曲线评价急性慢性血糖比值对不良预后的预测价值。应用Kaplan-Meier法绘制生存曲线，比较不同急性慢性血糖比值分组患者不良预后的发生风险。 结果 两组心功能分级比较差异有统计学意义（P<0.05），并且不良预后组总胆固醇、尿素氮、血糖、急性慢性血糖比值、高敏C反应蛋白、左心房前后径、右心房前后径均高于非预后不良组[（3.88 ± 0.18）mmol/L比（3.76 ± 0.24）mmol/L、（9.39 ± 1.07）mmol/L比（8.68 ± 1.79）mmol/L、（10.49 ± 2.20）mmol/L比（7.64 ± 1.57）mmol/L、1.37 ± 0.47比1.04 ± 0.35、（3.85 ± 0.36）mg/L比（3.68 ± 0.28）mg/L、（48.47 ± 7.86）mm比（45.37 ± 3.56）mm、（47.18 ± 5.04）mm比（44.05 ± 6.11）mm]，差异有统计学意义（P<0.05）。Cox多因素分析结果显示，高血压、白细胞计数、血钠、低密度脂蛋白胆固醇、急性慢性血糖比值是易损期发生不良预后的危险因素（P<0.05）。ROC曲线分析结果显示，急性慢性血糖比值预测易损期不良预后的曲线下面积为0.718（95CI 0.618~0.805，P<0.01），特异度为62.70%，灵敏度为77.40%，截断值为1.07。根据截断值将患者分为急性慢性血糖比值>1.07组（43例）和急性慢性血糖比值≤1.07组（55例）；生存分析结果显示，两组患者无终点事件生存率比较差异有统计学意义（P<0.01）。 结论 高急性慢性血糖比值的AHF患者出院后易损期不良预后发生风险高，急性慢性血糖比值可作为AHF患者易损期不良预后的预测指标。 Objective To explore the effect of acute and chronic glycemic ratio on the prognostic assessment in vulnerable phase of patients with acute heart failure (AHF). Methods The clinical data of 98 AHF patients who treatment in Nanjing Pukou Hospital of Traditional Chinese Medicine from May 2019 to May 2022 were collected retrospectively, the patients were followed up for 3 months, according to whether adverse events occurred in the vulnerable phase, the patients were divided into adverse prognosis group (31 cases) and non-adverse prognosis group(67 cases). The acute and chronic glycemic ratio was calculated based on the intravenous blood glucose and glycosylated hemoglobin (HbA1c). The influencing factors of adverse prognosis of AHF patients in vulnerable phase was analyzed by Cox risk proportion model, the predictive value of acute and chronic glycemic ratio on adverse prognosis was evaluated by receiver operating characteristic (ROC) curve. Kaplan-Meier method was used to draw the survival curve and compared the risk of adverse prognosis in patients with different acute and chronic glycemic ratio. Results The severity of cardiac function grading as well as total cholesterol, urea nitrogen, blood glucose, acute and chronic glycemic ratio, highly sensitive C-reactive protein (hs-CPR), left ventricular anteroposterior diameter, right atrial anteroposterior diameter in the adverse prognosis group were higher than those in the non-adverse prognosis group: (3.88 ± 0.18)mmol/L vs. (3.76 ± 0.24) mmol/L, (9.39 ± 1.07) mmol/L vs. (8.68 ± 1.79) mmol/L, (10.49 ± 2.20) mmol/L vs. (7.64 ± 1.57)mmol/L, 1.37 ± 0.47 vs. 1.04 ± 0.35, (3.85 ± 0.36) mg/L vs. (3.68 ± 0.28) mg/L, (48.47 ± 7.86) mm vs. (45.37 ± 3.56) mm, (47.18 ± 5.04) mm vs. (44.05 ± 6.11) mm, there were statistical differences (P<0.05). Cox multivariate analysis showed that hypertension, white blood cell count, blood sodium, low density lipoprotein cholesterol, acute and chronic glycemic ratio were the risk factors for adverse prognosis in vulnerable phase (P<0.05). The area under the curve of acute and chronic glycemic ratio for predicting adverse prognosis in vulnerable phase was 0.718 (95CI: 0.618 - 0.805, P<0.01), with specificity of 62.7%, sensitivity of 77.4%, and cut-off value of 1.07. According to the cut-off value of acute and chronic glycemic ratio, the patients were divided into acute and chronic glycemic ratio>1.07 group (43 cases), acute and chronic glycemic ratio≤ 1.07 group (55 cases), there was a statistically significant difference in the event free survival between the two groups (P<0.01). Conclusions AHF patients who with high acute and chronic glycemic ratio have a high risk of adverse prognosis in the vulnerable phase, which can be used as a predictor of the prognosis patients.
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