血糖间隙对非糖尿病急性ST段抬高型心肌梗死患者发生心肌缺血再灌注损伤的预测价值

doi:10.3877/cma.j.issn.1674-6880.2021.06.002

目的

探讨血糖间隙对非糖尿病急性ST段抬高型心肌梗死（STEMI）患者发生心肌缺血再灌注损伤（MIRI）的预测价值。

方法

选择2019年1月至12月就诊于首都医科大学附属北京安贞医院的541例非糖尿病STEMI患者。将男性、年龄、吸烟、发病时间、多支病变、入院时血糖（ABG）、糖化血红蛋白、血糖间隙、血肌酐、尿素氮、甘油三酯、总胆固醇、超敏C反应蛋白（hs-CRP）峰值、心肌肌钙蛋白I（cTNI）峰值纳入单因素Logistic回归分析，筛选出相关影响因素，之后纳入多因素Logistic回归分析，得到影响非糖尿病STEMI患者发生MIRI的独立危险因素。采用受试者工作特征（ROC）曲线分析其预测价值。

结果

经单因素Logistic回归分析，初步筛选出与非糖尿病STEMI患者发生MIRI有关的6个因素，包括ABG[比值比（OR）= 1.149，95%置信区间（CI）（1.037，1.273），P = 0.008]、血糖间隙[OR = 1.267，95%CI（1.121，1.432），P < 0.001]、尿素氮[OR = 1.153，95%CI（1.020，1.304），P = 0.023]、总胆固醇[OR = 0.791，95%CI（0.645，0.971），P = 0.025]、hs-CRP峰值[OR = 1.016，95%CI（1.006，1.026），P = 0.002]、cTNI峰值[OR = 1.010，95%CI（1.003，1.017），P = 0.008]。多因素Logistic回归分析结果显示，血糖间隙[OR = 1.537，95%CI（1.140，2.074），P = 0.005]、hs-CRP峰值[OR = 0.659，95%CI（1.004，1.024），P = 0.007]是非糖尿病STEMI患者发生MIRI的独立危险因素。ROC曲线分析结果显示，血糖间隙[曲线下面积= 0.609，95%CI（0.547，0.672），P = 0.001]对非糖尿病STEMI患者发生MIRI具有一定的预测价值。

结论

血糖间隙是非糖尿病STEMI患者发生MIRI的独立危险因素，对其发生MIRI具有预测价值。

关键词: 心肌缺血再灌注损伤, 血糖间隙, 急性ST段抬高型心肌梗死, 应激性高血糖, 危险因素

Objective

To investigate the predictive value of glycemic gap for myocardial ischemia reperfusion injury (MIRI) in non-diabetic patients with acute ST-segment elevation myocardial infarction (STEMI).

Methods

A total of 541 non-diabetic patients with STEMI admitted to Beijing Anzhen Hospotal, Capital Medical University from January to December 2019 were selected. The age, male, smoking, time of onset, multiple lesions, admission blood glucose (ABG), glycosylated hemoglobin, glycemic gap, blood creatinine, urea nitrogen, triglyceride, total cholesterol, hypersensitive C-reactive protein (hs-CRP) peak and cardiac troponin I (cTNI) peak were included in univariate Logistic regression analysis to screen out relevant influencing factors, and then included in multivariate Logistic regression analysis to obtain independent risk factors affecting MIRI in non-diabetic STEMI patients. The receiver operating characteristic (ROC) curve was used to analyze the predictive value.

Results

Six factors were associated with MIRI in non-diabetic STEMI patients by univariate Logistic regression analysis, including ABG [odds ratio (OR) = 1.149, 95% confidence interval (CI) (1.037, 1.273), P = 0.008], glycemic gap [OR = 1.267, 95%CI (1.121, 1.432), P < 0.001], urea nitrogen [OR = 1.153, 95%CI (1.020, 1.304), P = 0.023], total cholesterol [OR = 0.791, 95%CI (0.645, 0.971), P = 0.025], hs-CRP peak [OR = 1.016, 95%CI (1.006, 1.026), P = 0.002] and cTNI peak [OR = 1.010, 95%CI (1.003, 1.017), P = 0.008]. Multivariate Logistic regression analysis showed that glycemic gap [OR = 1.537, 95%CI (1.140, 2.074), P = 0.005] and hs-CRP peak [OR = 0.659, 95%CI (1.004, 1.024), P = 0.007] were independent risk factors for MIRI in non-diabetic STEMI patients. ROC curve analysis showed that glycemic gap [area under the curve = 0.609, 95%CI (0.547, 0.672), P = 0.001] had certain predictive value for the occurrence of MIRI in non-diabetic STEMI patients.

Conclusion

Glycemic gap is an independent risk factor for MIRI in non-diabetic STEMI patients and has predictive value for MIRI.

Key words: Myocardial ischemia-reperfusion injury, Glycemic gap, Acute ST-segment elevation myocardial infarction, Stress-induced hyperglycemia, Risk factors

表1 非糖尿病STEMI患者发生MIRI的单因素Logistic回归分析

变量	回归系数	标准误	Wald值	P值	OR值	95%CI
男性	0.443	0.286	2.407	0.121	1.557	0.890 ~ 2.725
年龄（岁）	0.008	0.010	0.649	0.420	1.008	0.989 ~ 1.027
吸烟	-0.021	0.230	0.009	0.927	0.979	0.624 ~ 1.535
发病时间（h）	-0.036	0.023	2.440	0.118	0.965	0.923 ~ 1.009
多支病变	-0.451	0.230	3.829	0.050	0.637	0.406 ~ 1.001
ABG（mmol / L）	0.139	0.052	7.027	0.008	1.149	1.037 ~ 1.273
HbA1c（mmol / L）	-0.243	0.190	1.635	0.201	0.784	0.541 ~ 1.138
血糖间隙（mmol / L）	0.237	0.063	14.315	< 0.001	1.267	1.121 ~ 1.432
血肌酐（μmol / L）	0.007	0.006	1.429	0.232	1.007	0.996 ~ 1.018
尿素氮（mmol / L）	0.142	0.063	5.183	0.023	1.153	1.020 ~ 1.304
甘油三酯（mmol / L）	-0.250	0.128	3.796	0.051	0.779	0.606 ~ 1.001
总胆固醇（mmol / L）	-0.234	0.104	5.043	0.025	0.791	0.645 ~ 0.971
hs-CRP峰值（mg / L）	0.016	0.005	9.478	0.002	1.016	1.006 ~ 1.026
cTNI峰值（μg / L）	0.010	0.004	7.019	0.008	1.010	1.003 ~ 1.017

表1 非糖尿病STEMI患者发生MIRI的单因素Logistic回归分析

变量	回归系数	标准误	Wald值	P值	OR值	95%CI
男性	0.443	0.286	2.407	0.121	1.557	0.890 ~ 2.725
年龄（岁）	0.008	0.010	0.649	0.420	1.008	0.989 ~ 1.027
吸烟	-0.021	0.230	0.009	0.927	0.979	0.624 ~ 1.535
发病时间（h）	-0.036	0.023	2.440	0.118	0.965	0.923 ~ 1.009
多支病变	-0.451	0.230	3.829	0.050	0.637	0.406 ~ 1.001
ABG（mmol / L）	0.139	0.052	7.027	0.008	1.149	1.037 ~ 1.273
HbA1c（mmol / L）	-0.243	0.190	1.635	0.201	0.784	0.541 ~ 1.138
血糖间隙（mmol / L）	0.237	0.063	14.315	< 0.001	1.267	1.121 ~ 1.432
血肌酐（μmol / L）	0.007	0.006	1.429	0.232	1.007	0.996 ~ 1.018
尿素氮（mmol / L）	0.142	0.063	5.183	0.023	1.153	1.020 ~ 1.304
甘油三酯（mmol / L）	-0.250	0.128	3.796	0.051	0.779	0.606 ~ 1.001
总胆固醇（mmol / L）	-0.234	0.104	5.043	0.025	0.791	0.645 ~ 0.971
hs-CRP峰值（mg / L）	0.016	0.005	9.478	0.002	1.016	1.006 ~ 1.026
cTNI峰值（μg / L）	0.010	0.004	7.019	0.008	1.010	1.003 ~ 1.017

表2 非糖尿病STEMI患者发生MIRI的多因素Logistic回归分析

变量	回归系数	标准误	Wald值	P值	OR值	95%CI
ABG（mmol / L）	-0.278	0.140	3.973	0.051	0.757	0.576 ~ 0.995
血糖间隙（mmol / L）	0.430	0.153	7.925	0.005	1.537	1.140 ~ 2.074
尿素氮（mmol / L）	0.091	0.055	2.719	0.099	1.095	0.983 ~ 1.220
总胆固醇（mmol / L）	-0.202	0.110	3.392	0.066	0.983	0.659 ~ 1.013
hs-CRP峰值（mg / L）	0.014	0.005	7.396	0.007	0.659	1.004 ~ 1.024
cTNI峰值（μg / L）	0.005	0.004	1.992	0.158	1.004	0.998 ~ 1.014

表2 非糖尿病STEMI患者发生MIRI的多因素Logistic回归分析

变量	回归系数	标准误	Wald值	P值	OR值	95%CI
ABG（mmol / L）	-0.278	0.140	3.973	0.051	0.757	0.576 ~ 0.995
血糖间隙（mmol / L）	0.430	0.153	7.925	0.005	1.537	1.140 ~ 2.074
尿素氮（mmol / L）	0.091	0.055	2.719	0.099	1.095	0.983 ~ 1.220
总胆固醇（mmol / L）	-0.202	0.110	3.392	0.066	0.983	0.659 ~ 1.013
hs-CRP峰值（mg / L）	0.014	0.005	7.396	0.007	0.659	1.004 ~ 1.024
cTNI峰值（μg / L）	0.005	0.004	1.992	0.158	1.004	0.998 ~ 1.014

图1 血糖间隙预测非糖尿病STEMI患者发生MIRI的ROC曲线分析注：STEMI.急性ST段抬高型心肌梗死；MIRI.心肌缺血再灌注损伤；ROC.受试者工作特征

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Predictive value of glycemic gap for myocardial ischemia reperfusion injury in non-diabetic patients with acute ST-segment elevation myocardial infarction

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Predictive value of glycemic gap for myocardial ischemia reperfusion injury in non-diabetic patients with acute ST-segment elevation myocardial infarction