吴晓鸿,李芳,岳坤,赵顺,李英凯,彭红玉

• 1:首都医科大学附属北京安贞医院冠心病中心

摘要(Abstract)：

目的 探讨甘油三酯-葡萄糖（TyG）指数对药物涂层球囊（DCB）治疗支架内再狭窄（ISR）患者术后主要不良心脑血管事件（MACCE）的预测价值。方法 回顾性分析2019年1—12月首都医科大学附属北京安贞医院408例接受DCB治疗的ISR患者。根据TyG指数三分位数分为T1组（≤8.47）、T2组（>8.47且≤8.89）、T3组（>8.89）。收集患者基线资料，以24个月MACCE（全因死亡、非致命性心肌梗死、非计划性再次血运重建、非致命性缺血性脑卒中）为主要终点，采用Cox回归分析TyG指数与MACCE的关联，Kaplan-Meier法分析累积风险差异。结果 408例患者男309例（75.7%），平均年龄（60.16±10.46）岁。按照TyG指数三分位数分为三组，T1组136例，T2组138例，T3组134例。三组患者男性比例、身体质量指数水平、糖尿病患病率、高血压患病率比较，差异均有统计学意义（均P<0.05）。在实验室检查方面，空腹血糖、甘油三酯、总胆固醇、低密度脂蛋白胆固醇随着TyG指数三分位数的增加而升高，差异均有统计学意义（均P<0.05），而HDL-C水平随着TyG指数三分位数的增加而降低（P<0.001）。TyG指数较高的患者中，使用降糖药物的比例更高（P<0.001）。在造影结果方面，TyG指数较高的患者中多支病变患者更多（P<0.001）；弥漫性病变中，T1组与T2组比较，差异无统计学意义；T1组与T3组比较，差异有统计学意义。在平均（23.09±3.56）个月的随访中，共有29例（7.1%）患者发生MACCE，随着TyG指数三分位数的增加而升高（2.9%比5.8%比12.7%,P=0.006），差异有统计学意义。TyG指数较高三分位数的患者比较低三分位数的患者，MACCE风险增加3.72倍（95%CI 1.37～16.26,P=0.014）。Kaplan-Meier曲线显示了TyG指数与DCB治疗ISR术后MACCE的累积风险。随着TyG指数三分位数的升高，MACCE的累积风险明显增加（Log-rank P=0.005）。结论 TyG指数是DCB治疗ISR患者术后MACCE的独立预测因子，可识别高危人群，为制订个性化干预策略提供依据。

关键词(KeyWords)： 甘油三酯-葡萄糖指数;支架内再狭窄;药物涂层球囊;胰岛素抵抗

Abstract:

Keywords:

基金项目(Foundation): 北京市属医院科研培育计划项目(PX2021026)

作者(Author): 吴晓鸿,李芳,岳坤,赵顺,李英凯,彭红玉

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