收稿日期: 2024-12-25
网络出版日期: 2025-04-23
基金资助
河南省科技研发计划联合基金项目(222103810054);郑州市科技惠民计划项目(202241000119)
Association between coronary inflammation and malnutrition on prognosis in patients with coronary artery disease
Received date: 2024-12-25
Online published: 2025-04-23
目的 探讨营养不良与冠状动脉炎症的关系，并探讨冠状动脉炎症在营养不良与主要心血管不良事件（MACE）之间的交互和中介作用。 方法 回顾性分析2018年5月至2022年7月在阜外华中心血管病医院诊断为冠心病的428例患者，所有患者均行冠状动脉计算机断层扫描血管造影术和冠状动脉造影术。采用新型营养指数（TCBI）和右冠状动脉近端周围的冠脉周围脂肪衰减指数（RCA-FAI）分别评价患者的营养状态和冠状动脉炎症。研究终点为MACE。使用线性回归模型分析TCBI和RCA-FAI之间的相关性。COX回归模型分析TCBI和RCA-FAI与发生MACE的相关性。通过中介分析评估RCA-FAI是否介导TCBI与发生MACE之间的关系。 结果 共有428例患者被纳入研究。RCA-FAI与TCBI呈负相关（r = -0.224，P < 0.001）。调整潜在混杂因素后，TCBI的每个标准差减量与RCA-FAI的2.20 HU增加相关（95% CI：-3.40 ~ -1.19，P < 0.001）。在平均2.15年的随访期内，发生了51例MACE。低TCBI/高RCA-FAI组发生MACE的风险是高TCBI/低RCA-FAI组的6.58倍（调整后HR = 6.580，95% CI：2.237 ~ 19.360，P = 0.001），且TCBI与RCA-FAI之间存在交互作用。中介分析表明，RCA-FAI介导了TCBI与MACE之间37.5%的相关性。 结论 营养不良和冠状动脉炎症对发生MACE存在显著的交互作用，并且冠状动脉炎症部分介导了营养不良和MACE之间的关系。TCBI联合RCA-FAI有助于识别具有高危心血管风险的患者。
陈璐琳 , 杨廷杰 , 孙猛 , 李新 , 郭一鸣 , 杨宇青 , 曹煜栋 , 李文哲 , 袁江淑 , 杨宏辉 . 营养不良与冠状动脉炎症对冠心病患者预后的影响[J]. 实用医学杂志, 2025 , 41(7) : 1010 -1017 . DOI: 10.3969/j.issn.1006-5725.2025.07.012
Objective This study aimed to investigate the relationship between malnutrition and coronary inflammation， and explore the interaction and mediating effects of coronary inflammation in the association between malnutrition and major adverse cardiovascular events （MACE）. Methods A retrospective analysis was conducted on 428 patients diagnosed with coronary heart disease at the Central China Fuwai Hospital from May 2018 to July 2022. All patients underwent coronary angiography （CAG） and coronary computed tomography angiography （CCTA）. The TCB index （triglycerides × total cholesterol × body weight） and the coronary fat attenuation index around the proximal right coronary artery （RCA?FAI） were used to assess patients' nutritional state and the degree of coronary inflammation， respectively.The study endpoint was MACE. We used linear regression models to analyze the correlation between TCBI and RCA?FAI， cox regression models to assess the correlation of TCBI and RCA?FAI with MACE， and mediation analysis to investigate whether RCA?FAI mediated the relationship between TCBI and MACE. Results A total of 428 patients were included in the study. There was a negative correlation between RCA?FAI and TCBI （r = -0.224， P < 0.001）. After adjusting for potential confounders， each standard deviation decrease in the TCBI index was associated with a 2.20 HU increase in RCA?FAI （95% CI： -3.40 ~ -1.19， P < 0.001）. During a mean follow?up period of 2.15 years， 51 MACE occurred. MACE risk in the low TCBI/high RCA?FAI group was 6.58 times higher than that in the high TCBI/low RCA?FAI group （adjusted HR = 6.580， 95%CI： 2.237 ~ 19.360， P = 0.001）， and the interaction between TCBI and RCA?FAI was identified.Mediation analysis revealed that RCA?FAI mediated 37.5% of the associations between TCBI and MACE. Conclusions In patients with coronary artery disease， malnutrition is associated with increased coronary inflammation. There is a significant interaction between malnutrition and coronary inflammation in the risk of MACE， and coronary inflammation partially mediates the relationship between malnutrition and MACE. The combination of the TCBI index and RCA?FAI can help identify patients at high cardiovascular risk. Improving malnutrition and controlling coronary inflammation may provide additional benefits for patients with coronary artery disease.
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