营养不良与冠状动脉炎症对冠心病患者预后的影响

doi:10.3969/j.issn.1006-5725.2025.07.012

Abstract

Abstract:

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.

Key words: coronary inflammation, nutritional index, malnutrition, major adverse cardiovascular events

CLC Number:

R543.3

Lulin CHEN,Tingjie YANG,Meng SUN,Xin LI,Yiming GUO,Yuqing YANG,Yudong CAO,Wenzhe LI,Jiangshu YUAN,Honghui YANG. Association between coronary inflammation and malnutrition on prognosis in patients with coronary artery disease[J]. The Journal of Practical Medicine, 2025, 41(7): 1010-1017.

Figures/Tables 8

Tab.1

Baseline characteristics of the research population"

特征	总体（n = 428）	TCBI三分位组			P值
特征	总体（n = 428）	T1（n = 142）	T2（n = 143）	T3（n = 143）	P值
年龄/岁	61.39 ± 11.19	65.37 ± 10.78	62.54 ± 10.87^?	56.30 ± 9.98^??##	< 0.001
男性/［例（%）］	304（71.0）	95（66.9）	99（69.2）	110（76.9）	0.148
BMI/（kg/m²）	25.88 ± 3.96	23.89 ± 3.54	25.61 ± 3.54^??	28.11 ± 3.62^??##	< 0.001
SBP/mmHg	138 ± 20	136 ± 20	141 ± 20^?	137 ± 20	0.098
DBP/mmHg	85 ± 13	81 ± 12	85 ± 12^??	88 ± 13^??	< 0.001
HR/（次/min）	76 ± 12	73 ± 13	76 ± 11	77 ± 12^??	0.025
吸烟史/［例（%）］	172（40.2）	55（38.7）	49（34.3）	68（47.6）^#	0.066
饮酒史/［例（%）］	160（37.4）	46（32.4）	52（36.4）	62（43.4）	0.153
高血压史/［例（%）］	273（63.8）	90（63.4）	88（61.5）	95（66.4）	0.685
心梗史/［例（%）］	18（4.2）	11（7.7）	5（3.5）	2（1.4）^?	0.025
脑梗史/［例（%）］	50（11.7）	27（19.0）	14（9.8）^?	9（6.3）^??	0.030
糖尿病史/［例（%）］	146（34.1）	45（31.7）	54（37.8）	47（32.9）	0.518
eGFR/（mL/min）	86.38 ± 16.68	82.66 ± 17.14	86.37 ± 16.59	90.08 ± 15.58^??	< 0.001
Cr/（mg/dL）	0.81 ± 0.26	0.81 ± 0.32	0.80 ± 0.26	0.81 ± 0.19	0.959
UA/（μmol/L）	308.41 ± 82.15	288.54 ± 74.86	291.45 ± 74.62	345.1 ± 84.37^??##	< 0.001
HbA1c/%	6.39 ± 1.25	6.29 ± 1.2	6.42 ± 1.13	6.45 ± 1.4	0.501
FPG/（mg/dL）	111.33 ± 42.29	103.34 ± 34.61	114.78 ± 42.49^?	115.8 ± 47.84^?	0.022
TC/（mg/dL）	155.17 ± 39.52	126.19 ± 28.05	158.57 ± 29.98^??	180.53 ± 38.95^??##	< 0.001
TG/（mg/dL）	138.54 ± 77.13	78.82 ± 22.14	126.83 ± 27.79^??	209.57 ± 88.58^??##	< 0.001
HDL-C/（mg/dL）	42.09 ± 9.98	44.68 ± 11.15	42.02 ± 8.63^?	39.59 ± 9.41^??##	< 0.001
LDL-C/（mg/dL）	232.2 ± 34.43	70.24 ± 24.1	98.04 ± 28.46^??	112.09 ± 35.63^??##	< 0.001
用药情况/［例（%）］
抗血小板/［例（%）］	103（24.1）	41（28.9）	36（25.2）	26（18.2）^?	0.100
降脂/［例（%）］	107（25.0）	45（31.7）	34（23.8）	28（19.6）^?	0.057
β受体阻滞剂/［例（%）］	64（15.0）	23（16.2）	21（14.7）	20（14.0）	0.867
ACEI/ARB/［例（%）］	81（18.9）	31（21.8）	22（15.4）	28（19.6）	0.370
住院期间PCI/CABG/［例（%）］	219（51.2）	71（50.0）	79（55.2）	69（48.3）	0.469

Tab.1

Fig.1

Tab.2

Fig.2

Tab.3

Fig.3

Tab.4

Fig.4

References 28

1	龙珊，刘兴德，李甜甜，等. 冠心病患者经皮冠状动脉介入治疗术后合并焦虑抑郁机制及治疗的研究进展［J］. 实用医学杂志，2023，39（21）：2850-2856. doi:10.3969/j.issn.1006-5725.2023.21.026 doi: 10.3969/j.issn.1006-5725.2023.21.026
2	国家心血管病中心，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2023概要［J］. 中国循环杂志，2024，39（7）：625-660.
3	CASAS-VARA A， SANTOLARIA F， FERNÁNDEZ-BERECIARTÚA A， et al. The obesity paradox in elderly patients with heart failure： analysis of nutritional status［J］. Nutrition， 2012， 28（6）：616-622. doi:10.1016/j.nut.2011.10.006 doi: 10.1016/j.nut.2011.10.006
4	张茸祯，贾敏，娄豆豆，等. 合并心血管疾病的高血压患者强化降压治疗研究进展［J］. 新医学，2024，55（4）：248-254.
5	LUO H， YANG H， HUANG B， et al. Geriatric Nutritional Risk Index （GNRI） Independently Predicts Amputation Inchronic Criticallimb Ischemia （CLI）［J］. PLoS One， 2016， 11（3）：e0152111. doi:10.1371/journal.pone.0152111 doi: 10.1371/journal.pone.0152111
6	KUNIMURA A， ISHII H， UETANI T， et al. Impact of Geriatric Nutritional Risk Index on cardiovascular outcomes in patients with stable coronary artery disease［J］. J Cardiol， 2017， 69（1）：383-388. doi:10.1016/j.jjcc.2016.09.004 doi: 10.1016/j.jjcc.2016.09.004
7	WADA H， DOHI T， MIYAUCHI K， et al. Prognostic Impact of the Geriatric Nutritional Risk Index on Long-Term Outcomes in Patients Who Underwent Percutaneous Coronary Intervention［J］. Am J Cardiol， 2017， 119（11）：1740-1745. doi:10.1016/j.amjcard.2017.02.051 doi: 10.1016/j.amjcard.2017.02.051
8	王晶晶，王巍东，王梦雨，等. 预后营养指数与尿素/肌酐比值在食管癌放化疗患者营养状态评估中的应用［J］. 实用医学杂志，2024，40（14）：1957-1962.
9	BOUILLANNE O， MORINEAU G， DUPONT C， et al. Geriatric Nutritional Risk Index： a new index for evaluating at-risk elderly medical patients［J］. Am J Clin Nutr， 2005， 82（4）：777-783. doi:10.1093/ajcn/82.4.777 doi: 10.1093/ajcn/82.4.777
10	NOZOE T， NINOMIYA M， MAEDA T， et al. Prognostic nutritional index： a tool to predict the biological aggressiveness of gastric carcinoma［J］. Surg Today， 2010， 40（5）：440-443. doi:10.1007/s00595-009-4065-y doi: 10.1007/s00595-009-4065-y
11	DOI S， IWATA H， WADA H， et al. A novel and simply calculated nutritional index serves as a useful prognostic indicator in patients with coronary artery disease［J］. Int J Cardiol， 2018， 262：92-98. doi:10.1016/j.ijcard.2018.02.039 doi: 10.1016/j.ijcard.2018.02.039
12	MINAMI-TAKANO A， IWATA H， MIYOSAWA K，et al. A Novel Nutritional Index Serves as A Useful Prognostic Indicator in Cardiac Critical Patients Requiring Mechanical Circulatory Support［J］. Nutrients， 2019， 11（6）：1420. doi:10.3390/nu11061420 doi: 10.3390/nu11061420
13	ISHIWATA S， YATSU S， KASAI T，et al. Prognostic Effect of a Novel Simply Calculated Nutritional Index in Acute Decompensated Heart Failure［J］. Nutrients， 2020， 12（11）：3311. doi:10.3390/nu12113311 doi: 10.3390/nu12113311
14	ANZAKI K， KANDA D， IKEDA Y， et al. Impact of Malnutrition on Prognosis and Coronary Artery Calcification in Patients with Stable Coronary Artery Disease［J］. Curr Probl Cardiol， 2023， 48（8）：101185. doi:10.1016/j.cpcardiol.2022.101185 doi: 10.1016/j.cpcardiol.2022.101185
15	曾师婷，黄志勇，陈林发，等. ADAMTS9对动脉粥样硬化斑块的作用及机制研究进展［J］. 新医学，2023，54（8）：545-548.
16	ANTONOPOULOS A S， SANNA F， SABHARWAL N，et al. Detecting human coronary inflammation by imaging perivascular fat［J］. Sci Transl Med， 2017， 9（398）：eaal2658. doi:10.1126/scitranslmed.aal2658 doi: 10.1126/scitranslmed.aal2658
17	OIKONOMOU E K， MARWAN M， DESAI M Y，et al. Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk （the CRISP CT study）： A post-hoc analysis of prospective outcome data［J］. Lancet， 2018， 392（10151）：929-939. doi:10.1016/s0140-6736(18)31114-0 doi: 10.1016/s0140-6736(18)31114-0
18	GOELLER M， TAMARAPPOO B K， KWAN A C，et al. Relationship between changes in pericoronary adipose tissue attenuation and coronary plaque burden quantified from coronary computed tomography angiography［J］. Eur Heart J Cardiovasc Imaging， 2019， 20（6）：636-643. doi:10.1093/ehjci/jez013 doi: 10.1093/ehjci/jez013
19	GOELLER M， ACHENBACH S， CADET S，et al. Pericoronary Adipose Tissue Computed Tomography Attenuation and High-Risk Plaque Characteristics in Acute Coronary Syndrome Compared With Stable Coronary Artery Disease［J］. JAMA Cardiol， 2018， 3（9）：858-863. doi:10.1001/jamacardio.2018.1997 doi: 10.1001/jamacardio.2018.1997
20	周蓓蕾，沈姣姣，单晶，等. 营养不良风险与冠心病患者冠状动脉狭窄程度的相关性研究［J］. 空军医学杂志，2022，38（2）：146-149.
21	罗慧，陈建国，何东元. 营养不良炎症动脉粥样硬化综合征研究进展［J］. 临床荟萃，2015，（5）：590-593.
22	NAKAGOMI A， KOHASHI K， MORISAWA T，et al. Nutritional Status is Associated with Inflammation and Predicts a Poor Outcome in Patients with Chronic Heart Failure［J］. J Atheroscler Thromb， 2016， 23（6）：713-727. doi:10.5551/jat.31526 doi: 10.5551/jat.31526
23	HE F， HUANG H， XU W， et al. Prognostic impact of malnutrition in patients with coronary artery disease： A systematic review and meta-analysis［J］. Nutr Rev， 2024， 82（8）：1013-1027. doi:10.1093/nutrit/nuad108 doi: 10.1093/nutrit/nuad108
24	KALANTAR-ZADEH K， ANKER S D， HORWICH T B， et al ．Nutritional and anti-inflammatory interventions in chronic heart failure［J］. Am J Cardiol， 2008， 101（11A）：89E-103E. doi:10.1016/j.amjcard.2008.03.007 doi: 10.1016/j.amjcard.2008.03.007
25	RAPOSEIRASROUBÍN S， ASSI E ABU， CESPÓN FERNANDEZ M， et al. Prevalence and Prognostic Significance of Malnutrition in Patients With Acute Coronary Syndrome［J］. J Am Coll Cardiol， 2020， 76（7）：828-840. doi:10.1016/j.jacc.2020.06.058 doi: 10.1016/j.jacc.2020.06.058
26	ZHU Y， XIAN X， WANG Z， et al. Research Progress on the Relationship between Atherosclerosis and Inflammation［J］. Biomolecules， 2018， 8（3）：80. doi:10.3390/biom8030080 doi: 10.3390/biom8030080
27	SAGRIS M， ANTONOPOULOS A S， SIMANTIRIS S， et al. Pericoronary fat attenuation index-a new imaging biomarker and its diagnostic and prognostic utility： A systematic review and meta-analysis［J］. Eur Heart J Cardiovasc Imaging， 2022， 23（12）：e526-e536. doi:10.1093/ehjci/jeac174 doi: 10.1093/ehjci/jeac174
28	KUHLMANN M K， LEVIN N W. Potential interplay between nutrition and inflammation in dialysis patients［J］. Contrib Nephrol， 2008， 161：76-82. doi:10.1159/000129759 doi: 10.1159/000129759

特征	模型1		模型2		模型3
特征	β（95% CI）	P值	β（95% CI）	P值	β（95% CI）	P值
P值		< 0.001		< 0.001		< 0.001
TCBI（per SD）	-2.33（-3.30 ~ -1.362）	< 0.001	-2.24（-3.27 ~ -1.21）	< 0.001	-2.20（-3.24 ~ -1.16）	< 0.001
TCBI
T1	1（Reference）		1（Reference）		1（Reference）
T2	-1.61（-4.01 ~ 0.79）	0.186	-1.44（-3.83 ~ 0.95）	0.235	-1.61（-3.86 ~ 1.05）	0.187
T3	-3.79（-6.19 ~ -1.39）	0.002	-3.32（-5.85 ~ -0.80）	0.009	-3.79（-6.18 ~ -1.40）	0.002

特征	模型1		模型2		模型3
特征	HR（95% CI）	P值	HR（95% CI）	P值	HR（95% CI）	P值
P 值						0.015
TCBI
≥ 1 360	Reference		Reference		Reference
< 1 360	2.194（1.214 ~ 3.967）	0.009	2.251（1.202 ~ 4.214）	0.011	2.202（1.169 ~ 4.146）	0.015
RCA-FAI
≤ -83.7	Reference		Reference		Reference
> -83.7	3.163（1.709 ~ 5.854）	< 0.001	2.980（1.602 ~ 5.541）	0.001	2.823（1.514 ~ 5.262）	0.001

特征	MACE 个案数	模型1		模型2		模型3
特征	MACE 个案数	HR（95% CI）	P值	HR（95% CI）	P值	HR（95% CI）	P值
高TCBI/低RCA-FAI	4	Reference		Reference		Reference
低TCBI/低RCA-FAI	10	2.743（0.859 ~ 8.758）	0.088	2.926（0.898 ~ 9.528）	0.151	2.459（0.751 ~ 8.057）	0.137
高TCBI/高RCA-FAI	12	3.969（1.280 ~ 12.309）	0.017	3.863（1.243 ~ 12.005）	0.019	3.147（1.001 ~ 9.888）	0.050
低TCBI/高RCA-FAI	25	7.421（2.582 ~ 21.331）	< 0.001	7.491（2.534 ~ 22.142）	< 0.001	6.580（2.237 ~ 19.360）	0.001
P 值			< 0.001		0.001		0.002
交互作用P值			0.013		0.012		0.015

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Association between coronary inflammation and malnutrition on prognosis in patients with coronary artery disease

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