临床研究

新型人体测量学指标与急性心肌梗死患者长期预后的相关性

  • 王凯阳 ,
  • 陶静 ,
  • 吴婷婷 ,
  • 永佳蕙 ,
  • 李国庆 ,
  • 谢翔 ,
  • 杨毅宁
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  • 1.新疆维吾尔自治区人民医院,心内科,(新疆 乌鲁木齐 830000 )
    2.新疆维吾尔自治区人民医院,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 )
    3.新疆医科大学第一附属医院心脏中心 (新疆 乌鲁木齐 830011 )

收稿日期: 2024-05-18

  网络出版日期: 2024-11-19

基金资助

新疆维吾尔自治区“科技创新领军人才项目-高层次领军人才”项目(2022TSYCLJ0028)

Correlation of novel anthropometric indicators with long⁃term prognosis in patients with acute myocardial infarction

  • Kaiyang WANG ,
  • Jing TAO ,
  • Tingting WU ,
  • Jiahui YONG ,
  • Guoqing LI ,
  • Xiang XIE ,
  • Yining. YANG
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  • *.Department of Cardiology,Xinjiang Uygur Autonomous Region People's Hospital,Urumqi 830000,Xinjiang,China
    *.Xinjiang Key Laboratory of Cardiovascular Homeostasis and Regenerative Medicine,Urumqi 830000,Xinjiang,China

Received date: 2024-05-18

  Online published: 2024-11-19

摘要

目的 探讨新型人体测量学指标对急性心肌梗死(AMI)患者长期预后的预测价值。 方法 连续纳入2018年1月至2019年12月期间就诊于新疆维吾尔自治区人民医院明确诊断为AMI的712例患者作为研究对象,根据随访期间是否发生主要心血管不良事件(MACEs)分为事件组和非事件组。Gensini评分用以定量评估冠脉病变程度,Spearman相关性分析探讨新型人体测量学指标与Gensini评分的相关性;受试者工作特征(ROC)曲线评估新型人体测量学指标对MACEs的预测能力,依据最佳截断值分组,Kaplan-Meier曲线分析组间生存差异;多因素Cox回归模型分析MACEs发生的独立影响因素。 结果 中位随访时间27(20,39)个月,共有125例患者发生MACEs,与非事件组患者相比,事件组患者合并高血压、糖尿病、腹型肥胖的比例更高,HbA1c和FBG水平更高,体质量及腰围较大,LAP指数、CMI指数、BRI指数及Gensini评分明显升高(P ? 0.05);Spearman相关性分析显示:LAP指数、CMI指数及BRI指数与Gensini评分呈正相关(r = 0.233、0.126、0.272,P < 0.001);ROC曲线分析结果显示:LAP指数、CMI指数、VAI指数、BRI指数及ABSI指数的AUC分别为0.745、0.640、0.490、0.874、0.506;Kaplan-Meier曲线分析结果显示:LAP指数、CMI指数和BRI指数高值组患者MACEs累积发生率显著增加(Log-rank test,P ? 0.05);调整混杂后多因素Cox 回归分析结果显示:CMI指数(HR = 1.430, 95%CI: 1.049 ~ 1.952, P = 0.024)和BRI指数(HR= 1.332, 95%CI: 1.234 ~ 1.439, P ? 0.001)是MACEs发生的独立危险因素。 结论 新型人体测量学指标CMI指数和BRI指数是AMI患者长期预后的独立危险因素。

本文引用格式

王凯阳 , 陶静 , 吴婷婷 , 永佳蕙 , 李国庆 , 谢翔 , 杨毅宁 . 新型人体测量学指标与急性心肌梗死患者长期预后的相关性[J]. 实用医学杂志, 2024 , 40(21) : 3040 -3046 . DOI: 10.3969/j.issn.1006-5725.2024.21.013

Abstract

Objective To explore the predictive value of novel anthropometric indicators for the long-term prognosis in patients with acute myocardial infarction (AMI). Methods A total of 712 patients diagnosed with AMI in the People's Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2019 were selected as research subjects, and divided into an event group and a non-event group according to whether major cardiovascular adverse events (MACEs) occurred during the period of follow-up. Gensini score was used to quantitatively assess the degree of coronary artery stenosis. Spearman correlation analysis was used to explore the correlation between the new anthropometric indicators and Gensini score. Receiver operating characteristic (ROC) curve was used to evaluate the ability of new anthropometric indicators to predict MACEs, and the patients were grouped according to the optimal cut-off value. Kaplan-Meier curve was used to analyze the survival difference between the groups. Multivariate Cox regression was used to analyze the independent risk factors of MACEs. Results During a median follow-up of 27(20,39)months, a total of 125 patients developed MACEs. As compared with those in the non-event group, the patients in the event group had a higher proportion of hypertension, diabetes and abdominal obesity, higher HbA1c and FBG levels, and longer body weight and waist circumference. The LAP index, CMI index, BRI index and Gensini score were significantly increased, and the differences were statistically significant (P ? 0.05). Spearman correlation analysis showed that LAP index, CMI index and BRI index were positively correlated with Gensini score (r = 0.233, 0.126, 0.272, P < 0.001). ROC curve analysis showed that the AUC of LAP index, CMI index, VAI index, BRI index and ABSI index were 0.745, 0.640, 0.490, 0.874 and 0.506 respectively; Kaplan-Meier curve analysis showed that the cumulative incidence of MACEs in LAP index, CMI index and BRI index was significantly increased in the high-value group (Log-rank test, P ? 0.05). The results of multivariate Cox regression analysis after adjusting confounding showed that CMI index (HR = 1.430, 95%CI: 1.049 ~ 1.952, P = 0.024) and BRI index (HR = 1.332, 95%CI: 1.234 ~ 1.439, P ? 0.001)were independent risk factors for MACEs. Conclusions CMI index and BRI index of new anthropometric indicators are independent risk factors for long-term prognosis in patients with AMI.

参考文献

1 LAWTON J S, TAMIS-HOLLAND J E, BANGALORE S, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J]. Circulation, 2022, 145(3): e4-e17. doi:10.1161/cir.0000000000001061
2 中国心血管健康与疾病报告编写组, 胡盛寿. 中国心血管健康与疾病报告2022概要[J]. 中国循环杂志, 2023, 38(6): 583-612. doi:10.3969/j.issn.1000-3614.2023.06.001
3 YUAN S, BRUZELIUS M, XIONG Y, et al. Overall and abdominal obesity in relation to venous thromboembolism[J]. J Thromb Haemost, 2021, 19(2): 460-469. doi:10.1111/jth.15168
4 秦叶叶, 李燕, 郑路, 等. 评估内脏型肥胖的新型人体测量学指标研究进展[J]. 国际内分泌代谢杂志, 2021, 41(3):207-211.
5 BYRNE R A, ROSSELLO X, COUGHLAN J J, et al. 2023 ESC Guidelines for the management of acute coronary syndromes[J]. Eur Heart J, 2023, 44(38): 3720-3826.
6 WANG K Y, ZHENG Y Y, WU T T, et al. Predictive Value of Gensini Score in the Long-Term Outcomes of Patients With Coronary Artery Disease Who Underwent PCI[J]. Front Cardiovasc Med, 2021, 8: 778615. doi:10.3389/fcvm.2021.778615
7 REYNOLDS H R, SHAW L J, MIN J K, et al. Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and Ischemia Severity[J]. Circulation, 2021,144(13):1024-1038.
8 MANCIA G, KREUTZ R, BRUNSTR?M M, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA) [J]. J Hypertens, 2023, 41(12): 1874-2071.
9 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2020年版)(上)[J]. 中国实用内科杂志, 2021, 41(8):668-695.
10 中华医学会心血管病学分会高血压学组, 中华心血管病杂志编辑委员会. 中国高血压患者血压血脂综合管理的专家共识[J]. 中华心血管病杂志, 2021, 49(6): 554-563.
11 中国营养学会肥胖防控分会, 中国营养学会临床营养分会, 中华预防医学会行为健康分会, 等. 中国居民肥胖防治专家共识[J]. 中华流行病学杂志, 2022, 43(5): 609-626.
12 中国营养学会肥胖防控分会, 中国营养学会临床营养分会, 中华预防医学会行为健康分会, 等. 中国居民肥胖防治专家共识[J]. 中国预防医学杂志, 2022, 23(5): 321-339.
13 WANG Y, ZHAO L, GAO L, et al. Health policy and public health implications of obesity in China [J]. Lancet Diabetes Endocrinol, 2021, 9(7): 446-461. doi:10.1016/s2213-8587(21)00118-2
14 HOTAMISLIGIL G S. Inflammation and metabolic disorders [J]. Nature, 2006, 444(7121): 860-867. doi:10.1038/nature05485
15 CHEN Z, IONA A, PARISH S, et al. Adiposity and risk of ischaemic and haemorrhagic stroke in 0.5 million Chinese men and women: A prospective cohort study[J]. Lancet Glob Health, 2018, 6(6): e630–e640.
16 李岳航, 王愿, 李义帅, 等. 内脏脂肪在肺癌中的研究进展[J].实用医学杂志,2022, 38(10):1292-1297.
17 XU C, GUO Y, ZHANG S, et al. Visceral adiposity index and the risk of heart failure, late-life cardiac structure, and function in ARIC study[J]. Eur J Prev Cardiol, 2023, 30(12): 1182-1192. doi:10.1093/eurjpc/zwad099
18 伍朝春, 黄政德, 庞羽, 等. 肥胖症多学科协作诊疗模式研究进展[J].实用医学杂志,2023,39(12):1588-1592. doi:10.3969/j.issn.1006-5725.2023.12.022
19 KYROU I, PANAGIOTAKOS D B, KOULI G M, et al. Lipid accumulation product in relation to 10-year cardiovascular disease incidence in Caucasian adults: The ATTICA study[J]. Atherosclerosis, 2018, 279: 10-16. doi:10.1016/j.atherosclerosis.2018.10.015
20 WAKABAYASHI I, DAIMON T. The "cardiometabolic index" as a new marker determined by adiposity and blood lipids for discrimination of diabetes mellitus[J]. Clin Chim Acta, 2015, 438: 274-278. doi:10.1016/j.cca.2014.08.042
21 SHI W R, WANG H Y, CHEN S, et al. Estimate of prevalent diabetes from cardiometabolic index in general Chinese population: a community-based study[J]. Lipids Health Dis, 2018, 17(1):236. doi:10.1186/s12944-018-0886-2
22 THOMAS D M, BREDLAU C, BOSY-WESTPHAL A, et al. Relationships between body roundness with body fat and visceral adipose tissue emerging from a new geometrical model[J]. Obesity (Silver Spring), 2013, 21(11): 2264-2271. doi:10.1002/oby.20408
23 RICO-MARTíN S, CALDERóN-GARCíA J F, SáNCHEZ-REY P, et al. Effectiveness of body roundness index in predicting metabolic syndrome: A systematic review and meta-analysis[J]. Obes Rev, 2020, 21(7): e13023. doi:10.1111/obr.13023
24 KRAKAUER N Y, KRAKAUER J C. A new body shape index predicts mortality hazard independently of body mass index[J]. PLoS One, 2012, 7(7): e39504. doi:10.1371/journal.pone.0039504
25 JI M, ZHANG S, AN R. Effectiveness of A Body Shape Index (ABSI) in predicting chronic diseases and mortality: a systematic review and meta-analysis[J]. Obes Rev, 2018, 19(5): 737-759. doi:10.1111/obr.12666
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