程梦瑶,张银珠,李佳唯,张钲

• 1:兰州大学第一医院(第一临床医学院)
• 2:兰州大学第一医院心脏中心

摘要(Abstract)：

目的 探讨新型炎症-胰岛素抵抗指标C反应蛋白（CRP）-甘油三酯葡萄糖（TyG）指数（CTI）与冠状动脉慢性完全闭塞（CTO）病变患者冠状动脉侧支循环（CCC）形成不良的相关性。方法 回顾性纳入2024年1月至2025年6月于兰州大学第一医院住院，并经冠状动脉造影（CAG）确诊至少1支心外膜冠状动脉CTO病变的患者793例。根据Rentrop分级将患者分为CCC形成不良组（0～1级）和形成良好组（2～3级）。收集空腹血脂、血糖及CRP等生化指标，计算CTI值：CTI=0.412×Ln[CRP(mg/L)]+TyG指数。采用Logistic回归分析评估CTI与CCC形成不良的关联，并建立多变量模型验证其独立性。通过受试者工作特征（ROC）曲线及DeLong检验比较模型判别效能，结合综合判别改善指数（IDI）与净重分类指数（NRI）评估增益价值，并以决策曲线分析评价临床获益。结果 共纳入CTO病变患者793例，其中CCC形成良好组473例（59.6%）,CCC形成不良组320例（40.4%）。CCC形成不良组的身体质量指数、CRP、空腹血糖、甘油三酯、D-二聚体、糖化血红蛋白、TyG指数及CTI水平均显著升高，而高密度脂蛋白胆固醇水平显著降低（均P<0.05）。按CTI三分位数分组后，CCC形成不良的发生率随CTI水平升高而显著增加。多因素Logistic分析显示，CTI升高为CCC形成不良的独立危险因素（OR 1.450,95%CI 1.211～1.736,P<0.001）。ROC曲线分析显示，CTI预测CCC不良的曲线下面积（AUC）为0.619，优于CRP(AUC=0.607)和TyG指数（AUC=0.568）；在基线模型中加入CTI后，AUC由0.652提升至0.698(P<0.001)。IDI、NRI和决策曲线分析进一步证实，CTI较TyG指数和CRP具有更优的模型增益效果与临床判别价值。结论 CTI升高与CTO病变患者CCC形成不良风险增加显著相关，有望作为评估CTO病变患者CCC状态的潜在生物标志物。

关键词(KeyWords)： 冠心病;慢性完全闭塞;侧支循环;炎症;胰岛素抵抗

Abstract:

Keywords:

基金项目(Foundation): 国家重大疑难疾病中西医临床协作试点项目（国中医药办医政发[2018]3号）;; 甘肃省心血管病临床医学研究中心项目（18JR2FA005）

作者(Author): 程梦瑶,张银珠,李佳唯,张钲

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