2021 年第 6 期 第 16 卷

三酰甘油葡萄糖乘积指数对老年慢性心力衰竭合并心房颤动患者预后的预测价值

The predictive value of triglyceride-glucose index in the prognosis of elderly patients with heart failure and atrial fibrillation

作者：侯良平刘思泰贾冬霞郑航

英文作者：Hou Liangping Liu Sitai Jia Dongxia Zheng Hang

单位：四川绵阳四〇四医院老年病科621000

英文单位：Department of Geriatrics Sichuan Mianyang 404 Hospital Mianyang 621000 China

关键词：慢性心力衰竭；心房颤动；三酰甘油葡萄糖乘积指数

英文关键词：Chronicheartfailure;Atrialfibrillation;Triglyceride-glucoseindex

• 摘要：

• 目的 探讨三酰甘油葡萄糖乘积(TyG)指数对老年慢性心力衰竭（CHF）合并心房颤动患者预后的预测价值。方法 选取2015年10月至2017年6月四川绵阳四〇四医院心内科收治的确诊为CHF合并心房颤动患者395例作为研究对象，所有患者随访3年，根据是否发生主要不良心血管事件（MACE）将患者分为MACE组（125例）和非MACE组（270例），采用多因素Logistic回归方法分析患者发生MACE的独立预测因素。再根据TyG指数四分位数分为4组，即TyG指数＜5.21组（A组，98例）、5.21≤TyG指数＜7.63组（B组，98例）、7.63≤TyG指数＜10.21组（C组，98例）和TyG指数≥10.21组（D组，101例）。Kaplan-Meier生存曲线分析4组的MACE发生时间；受试者工作特征曲线评价TyG指数对MACE的预测价值。结果 多因素Logistic回归分析结果显示，年龄、三酰甘油、空腹血糖、心肌肌钙蛋白I、N末端B型脑钠肽前体、TyG指数增加/升高，左心室射血分数降低，伴有高脂血症、糖尿病及纽约心脏病协会心功能分级Ⅲ～Ⅳ级是发生MACE的独立预测因素（均P＜0.05）。A、B、C、D组MACE发生时间分别为（28.4±2.3）、（24.9±2.1）、（22.4±1.8）、（19.7±1.7）个月。TyG指数预测老年CHF合并心房颤动患者发生MACE的曲线下面积为0.824（95%置信区间：0.792～0.871，P＜0.001），最佳临界值为8.12，敏感度为89.13%，特异度为64.22%。结论 TyG指数可作为老年CHF合并心房颤动患者发生MACE的独立预测因子。

• Objective  To investigate the predictive value of triglyceride-glucose (TyG) index in elderly patients with chronic heart failure(CHF) and atrial fibrillation(AF). Methods From October 2015 to June 2017, 395 patients with CHF and AF diagnosed in Department of Cardiology, Sichuan Mianyang 404 Hospital were selected. All patients were followed-up for 3 years. According to the occurrence of major adverse cardiovascular events (MACE), they were divided into the MACE group(125 cases) and the non-MACE group(270 cases). Multivariate Logistic regression analysis was used to analyze the independent predictors for MACE in patients. According to TyG index quartile level, the patients were divided into TyG index＜5.21 group(group A,98 cases), 5.21≤TyG index＜7.63 group(group B,98 cases), 7.63≤TyG index＜10.21 group(group C, 98 cases) and TyG index≥10.21 group(group D, 101 cases). Kaplan-Meier survival curve was used to analyze the occurrence time of MACE in the four groups. The receiver operating characteristic curve evaluated the prognostic value of TyG index in MACE. Results Multivariate Logistic regression analysis showed that age, triglyceride, fasting blood glucose, cardiac troponin I, N-terminal pro-brain natriuretic peptide, TyG index increasing/rising, left ventricular ejection fraction decreasing, and accompanied by hyperlipidemia, diabetes and New York Heart Association cardiac function grade Ⅲ-Ⅳ were independent predictors for MACE (all P＜0.05). The occurrence time of MACE in group A, B, C and D was (28.4±2.3), (24.9±2.1), (22.4±1.8) and (19.7±1.7)months, respectively. The area under the curve of TyG index predicting MACE in patients with CHF and AF was 0.824 (95% confidence interval: 0.792-0.871, P＜0.001), the best cut-off value was 8.12, the sensitivity was 89.13%, and the specificity was 64.22%. Conclusion TyG index level can be used as an independent predictor for MACE in elderly patients with CHF and AF.