摘要
目的 探讨急性心肌梗死(AMI)冠脉介入治疗前后甘油三酯葡萄糖指数(TyG)及心率变异性的监测价值及预后影响因素.方法 选取2020年3月到2023年3月佳木斯市中心医院收治的90例AMI患者进行回顾性分析,所有患者均采取冠脉介入治疗,对所有患者进行1年门诊复查随访,分析其治疗情况及预后,并对比其治疗前后TyG及心率变异性变化,建立受试者操作特征(ROC)曲线,分析治疗后TyG及心率变异性指标对AMI后不良心血管事件的诊断价值.随后将术后1年发生心血管不良事件的20例患者分为预后不良组,其余为预后良好组.多因素Logistics回归分析影响AMI介入治疗预后的因素.结果 90例AMI患者27例行急诊PCI,63例行择期PCI,单支血管病变患者42例,2支及以上48例,通过对患者进行1年随访,20例患者发生不良心血管事件.治疗后TyG为7.28±1.49,低于治疗前,治疗后全程相邻R-R间期差值均方根值(rMSSD)、全部正常窦性心搏R-R间期标准差(SDNN)及5 min心搏间期均值标准差(SDANN)分别为(37.62±6.24)ms、(120.51±12.37)ms、(126.62±16.66)ms,均高于治疗前,差异均有统计学意义(P＜0.05).TyG联合心率变异性指标的诊断敏感度为71.57％,特异度为83.56％,联合诊断明显高于单一指标诊断;预后良好组与预后不良组患者性别、体重指数、饮酒史、PCI治疗时机、左心室射血分数、预后危险(TIMI)评分比较,差异均无统计学意义(P＞0.05),预后良好组与预后不良组患者年龄、发病到PCI时间、合并基础疾病、Killip心功能分级、吸烟史、冠脉病变支数、TIMI评分、TyG、rMSSD、SDNN、SDANN比较,差异均有统计学意义(P＜0.05).结果显示,年龄、发病到PCI时间、Killip心功能分级、TyG、rMSSD、SDNN、SDANN是影响AMI介入治疗预后的独立危险因素(P＜0.05).结论 AMI采取冠脉介入治疗术后1年不良心血管事件发生率达22.22％,通过冠脉介入治疗可降低患者机体TyG水平,改善心率变异性;治疗后采用TyG联合心率变异性指标和提升对不良心血管事件的诊断价值;进一步分析发现,年龄、发病到PCI时间、Killip心功能分级、TyG及心率变异性为其预后不良的影响因素.
Abstract
Objective To explore the monitoring value and prognostic factors of triacylglycerol glucose index(TyG)and heart rate varia-bility before and after coronary intervention in acute myocardial infarction(AMI).Methods A retrospective analysis was conducted on 90 pa-tients with AMI admitted to Jiamusi Central Hospital from March 2020 to March 2023.All patients received coronary intervention treatment,and a one-year outpatient follow-up was conducted to analyze their treatment status and prognosis.The changes in TyG and heart rate variability before and after treatment were compared,and the diagnostic value of TyG and heart rate variability indicators for adverse cardiovascular events after AMI was analyzed by establishing receiver operating characteristic(ROC)curve.Subsequently,20 patients who experienced cardiovascular adverse e-vents one year after surgery were divided into a poor prognosis group and the rest were in a good prognosis group.Logistic regression models were used to analyze the prognostic factors of coronary intervention for AMI.Results Among the 90 patients with AMI,27 underwent emergency PCI,63 underwent elective PCI,42 had single vessel lesions,and 48 had 2 or more vessels.Through one-year follow-up,20 patients experienced adverse cardiovascular events.TyG after treatment was 7.28±1.49,which was lower than that before treatment;the root mean square value of the difference between root mean square of successive differences of adjacent R-R intervals(rMSSD),standard deviation of R-R interval for all normal sinus beats(SDNN),and mean standard deviation of 5-minute heart beat interval(SDANN)were(37.62±6.24)ms,(120.51±12.37)ms,and(126.62±16.66)ms,respectively,which were higher than those before treatment,the differences were statistically significant(P＜0.05).The diagnostic sensitivity of TyG combined with heart rate variability index was 71.57％,and the specificity was 83.56％.The combined diagnosis was significantly higher than the single index diagnosis.There was no statistically significant difference between gender,body mass index,alcohol history,timing of PCI,left ventricular ejection fraction,and risk of prognosis(TIMI)score between the good and poor prog-nosis groups(P＞0.05).Age,time from onset to PCI,underlying disease,Killip grade,smoking history,coronary lesions,TIMI score,TyG,rMSSD,SDNN,and SDANN(P＜0.05).The results showed that age,time from onset to PCI,Killip cardiac function grade,TyG,rMSSD,SDNN,and SDANN were independent risk factors affecting the prognosis of interventional therapy for AMI(P＜0.05).Conclusion The inci-dence of adverse cardiovascular events one year after coronary intervention for AMI is 22.22％.Coronary intervention can reduce TyG levels in pa-tients and improve heart rate variability;After treatment,TyG combined with heart rate variability indicators is used to enhance the diagnostic value of adverse cardiovascular events;Further analysis revealed that age,time from onset to PCI,Killip heart function grading,TyG,and heart rate variability are the influencing factors for poor prognosis.
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