Relationship between triglyceride-glucose index and contrast-induced nephropathy after PCI in patients with acute myocardial infarction
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摘要: 目的 探讨甘油三酯-葡萄糖(TyG)指数与急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后发生造影剂肾病(CIN)的相关性。 方法 对2017年1月—2022年5月于福建医科大学附属闽东医院接受PCI的308例AMI患者进行回顾性分析，观察患者的临床特点，计算TyG指数，记录术前和术后3 d内的血肌酐水平及其他生化指标、临床用药及超声心动图结果。根据PCI术后是否发生CIN，将患者分为CIN组(38例)和非CIN组(270例)。比较两组患者临床资料的差异，采用单因素和多因素logistic回归分析筛选CIN的独立危险因素，采用受试者工作特征曲线(ROC)评估TyG指数对CIN的预测价值。 结果 多因素logistic回归分析显示，年龄(OR=1.049，95%CI：1.001~1.100，P=0.046)和TyG指数(OR=3.929，95%CI：1.553~9.939，P=0.004)为AMI患者PCI术后CIN的独立危险因素，血红蛋白(OR=0.95，95%CI：0.925~0.975，P＜0.01)为保护性因素。TyG指数预测AMI患者PCI术后发生CIN的曲线下面积(AUC)为0.652(95%CI：0.554~0.750，P=0.002)。 结论 TyG指数可作为有效识别AMI患者PCI术后发生CIN的早期生物标志物，且CIN发生率随TyG水平的增高而升高。
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关键词:
- 急性心肌梗死 /
- 经皮冠状动脉介入 /
- 造影剂肾病 /
- 甘油三酯-葡萄糖指数
Abstract: Objective To investigate the relationship between triglyceride-glucose(TyG) index and contrast-induced nephropathy(CIN) after percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI). Methods A retrospective analysis was performed on 308 AMI patients who underwent PCI from January 2017 to May 2022 in Mindong Hospital Affiliated to Fujian Medical University. Clinical characteristics of patients were observed and the TyG index was calculated. Serum creatinine level and other biochemical indexes, clinical medication and cardiac color ultrasound results were recorded before and 3 days after PCI. According to whether CIN occurred after PCI, patients were divided into the CIN group (n=38) and non-CIN group (n=270). Clinical data between the two groups were compared, univariate and multivariate logistic regression analysis was used to explore independent risk factors of CIN, and receiver operating characteristic curve(ROC) was used to evaluate the predictive value of the TyG index for predicting CIN. Results Multivariate logistic regression analysis showed that TyG index(OR=3.929, 95%CI: 1.553-9.939, P=0.004) and age(OR=1.049, 95%CI: 1.001-1.100, P=0.046) were independent risk factors for CIN after PCI in AMI patients, while hemoglobin(OR=0.95, 95%CI: 0.925-0.975, P < 0.01) was a protective factor. The area under the curve(AUC) that TyG index predicted CIN in AMI patients after PCI was 0.652(95%CI: 0.554-0.750, P=0.002). Conclusion TyG index is an effective early biomarker to identify CIN after PCI in AMI patients, and the incidence of CIN increases with the increase of TyG level. -
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图 1 TyG指数预测AMI患者PCI术后CIN的ROC曲线
Figure 1. The ROC curve of TyG index predicting CIN after PCI in AMI patients
图 2 TyG指数预测AMI合并糖尿病患者PCI术后CIN的ROC曲线
Figure 2. The ROC curve of TyG index predicting CIN after PCI in AMI patients with diabetes mellitus
图 3 TyG指数预测无糖尿病AMI患者PCI术后CIN的ROC曲线
Figure 3. The ROC curve of TyG index predicting CIN after PCI in AMI patients without diabetes mellitus
表 1 非CIN组和CIN组临床资料比较
Table 1. Comparison of clinical data between the non-CIN group and CIN group
例(%), M(P25, P75) 项目 非CIN组(270例) CIN组(38例) P值 男性/例 213(78.9) 25(65.8) 0.71 年龄/岁 64(55，71) 72(66，75) ＜0.01 吸烟史 162(60.0) 21(55.3) 0.578 高血压史 156(57.8) 25(66.0) 0.108 糖尿病史 83(30.7) 22(57.9) ＜0.01 心房颤动史 13(4.8) 1(2.7) 0.545 慢性肾功能不全史 40(15.0) 7(18.4) 0.357 冠心病史 87(32.2) 11(30.0) 0.876 射血分数/% 59(54，63) 60(51，64) 0.771 造影剂剂量/mL 140(120，150) 145(125，160) 0.926 围术期用药 利尿剂 79(29.3) 14(36.8) 0.340 CCB 25(9.3) 4(10.5) 0.802 ACEI/ARB/ARNI 182(67.4) 23(60.5) 0.400 β受体阻滞剂 217(80.4) 28(73.7) 0.339 降糖药物 78(28.9)) 20(52.6) ＜0.01 CCB：钙离子通道阻滞剂；ACEI/ARB/ARNI：血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂/血管紧张素受体脑啡肽酶抑制。 
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表 2 非CIN组和CIN组实验室数据比较
Table 2. Comparison of laboratory data between the non-CIN group and CIN group
M(P25, P75), X±S 项目 非CIN组(270例) CIN组(38例) P值 白细胞计数/(×109/L) 10.40(8.05，12.90) 8.60(6.85，11.25) 0.476 血红蛋白/(g/L) 142.78±16.94 124.66±24.37 ＜0.01 血小板计数/(×109/L) 236.0(198.5，270.5) 244.0(207.0，270.5) 0.571 天门冬氨酸转氨酶/(U/L) 70.0(31.5，231.5) 82.0(39.0，232.0) 0.320 乳酸脱氢酶/(U/L) 530.0(347.0，1 001.5) 555.0(431.0，958.5) 0.597 丙氨酸转氨酶/(U/L) 37.0(24.0，63.5) 32.0(23.5，38.0) 0.252 肌酸激酶同工酶/(U/L) 90.0(20.0，234.5) 109.0(21.5，233.5) 0.416 白蛋白/(g/L) 39.60(37.20，41.70) 38.10(36.20，41.65) 0.022 总胆红素/(μmol/L) 12.20(9.50，16.20) 11.00(7.85，15.90) 0.056 碱性磷酸酶/(U/L) 73.0(62.0，86.0) 66.0(58.5，84.0) 0.153 血钾/(mmol/L) 4.10(3.80，4.40) 4.00(3.55，4.10) 0.041 血钠/(mmol/L) 139.0(138.0，141.0) 140.0(135.0，142.0) 0.480 尿素氮/(mmol/L) 5.70(4.81，7.15) 5.90(4.55，6.85) 0.405 肌酐/(μmol/L) 71.30(61.90，87.05) 69.70(50.65，87.80) 0.906 尿酸/(μmol/L) 354.30(298.75，420.60) 289.30(267.20，341.60) 0.022 空腹血糖/(mmol/L) 6.23(5.29，7.69) 8.95(5.78，12.89) ＜0.01 TG/(mmol/L) 1.66(1.16，2.21) 2.04(1.26，2.57) 0.591 TC/(mmol/L) 4.73(4.06，5.60) 4.72(4.14，5.62) 0.532 LDL-C/(mmol/L) 3.00(2.46，3.63) 2.94(2.34，3.48) 0.273 载脂蛋白A1/(g/L) 1.15(1.03，1.28) 1.20(1.08，1.30) 0.413 载脂蛋白B/(g/L) 0.94(0.80，1.11) 0.92(0.78，1.09) 0.287 纤维蛋白原/(g/L) 3.38(3.00，3.85) 3.32(2.85，3.82) 0.888 D二聚体/(mg/L) 46.00(0.61，184.50) 46.30(0.75，117.00 0.950 TyG指数 9.09(8.68，9.47) 9.40(9.00，9.86) ＜0.01
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表 3 CIN危险因素的logistic回归分析
Table 3. Risk factors of CIN analyzed by logistic regression analysis
变量 单因素分析 多因素分析 OR 95%CI P值 OR 95%CI P值 年龄 1.055 1.022~1.109 0.001 1.049 1.001~1.100 0.046 血红蛋白 0.951 0.933~0.971 ＜0.01 0.95 0.925~0.975 ＜0.01 白蛋白 0.907 0.831~0.991 0.03 0.995 0.889~1.113 0.931 总胆红素 0.932 0.871~0.997 0.041 0.947 0.871~1.029 0.198 血钾 0.469 0.226~0.974 0.042 0.496 0.220~1.109 0.089 尿酸 0.996 0.992~1.000 0.031 0.998 0.993~1.002 0.252 空腹血糖 1.192 1.091~1.303 ＜0.01 1.115 0.968~1.286 0.127 TyG指数 2.350 1.339~4.124 0.003 3.929 1.553~9.939 0.004 糖尿病史 3.098 1.548~6.201 0.001 1.166 0.399~3.405 0.972 降糖药物使用 2.332 1.145~4.752 0.02 1.177 0.342~4.047 0.796 冠心病病史 1.872 0.238~14.728 0.552 慢性肾功能不全病史 0.425 0.311~0.566 0.998 高血脂病史 0.508 0.149~1.732 0.279 降脂药物使用 0.698 0.079~6.141 0.746 高血压病史 1.405 0.689~2.865 0.349
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