2025 年第 7 期 第 20 卷

甘油三酯-葡萄糖指数与射血分数保留型心力衰竭患者心房颤动导管消融后复发的相关性研究

Study on the correlation between triglyceride-glucose index and recurrence of atrial fibrillation after catheter ablation in heart failure patients with preserved ejection fraction

作者：赵小湃石继慧彭晓东马长生

英文作者：Zhao Xiaopai Shi Jihui Peng Xiaodong Ma Changsheng

单位：首都医科大学附属北京安贞医院心律失常中心，北京100029

英文单位：Arrhythmia Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：心房颤动；射血分数保留型心力衰竭；导管消融；胰岛素抵抗；危险因素

英文关键词：Atrialfibrillation;Heartfailurewithpreservedejectionfraction;Catheterablation;Insulinresistance;Riskfactors

• 摘要：

• 目的 评估甘油三酯-葡萄糖（TyG）指数与射血分数保留型心力衰竭（HFpEF）患者心房颤动导管消融后复发的相关性，以探索新的复发风险分层指标。方法 本研究基于前瞻性、多中心的中国心房颤动注册队列，纳入2011年8月至2020年12月首次接受导管消融且符合HFpEF诊断标准的心房颤动患者413例。TyG指数通过基线甘油三酯与空腹血糖计算。主要结局为消融90 d空白期后的心房颤动复发。患者根据TyG指数第一和第三四分位数（Q1：8.44，Q3：8.96）进行分层，分为TyG指数低水平组（TyG指数<8.44，137例）、TyG指数中水平组（TyG指数8.44～8.96，139例）以及TyG指数高水平组（TyG指数>8.96，137例）。采用Kaplan-Meier生存分析和多因素校正Cox比例风险回归模型评估TyG指数与心房颤动复发的关联。结果 413例患者年龄（61±11）岁，男性253例（61.3%）。在中位随访810 d期间， 256例（62.0%）发生心房颤动复发事件。TyG指数每升高1个标准差，心房颤动复发风险增加29%（校正风险比=1.29，95%置信区间：1.07～1.55，P=0.007）。限制性立方样条图分析显示，TyG指数与复发风险呈剂量-反应关系。与TyG指数低水平组相比，TyG指数中、高水平组的心房颤动复发风险分别增加74%（校正风险比=1.74，95%置信区间：1.21～2.50，P=0.003）和106%（校正风险比=2.06，95%置信区间：1.36～3.13，P=0.001），趋势检验P=0.001。结论 在心房颤动合并HFpEF患者中，TyG指数升高与导管消融后心房颤动复发风险显著增加相关，且呈现剂量-反应关系。TyG指数作为反映胰岛素抵抗的经济实用指标，可用于指导该人群复发风险分层与个体化管理。

• Objective  To evaluate the correlation between triglyceride glucose (TyG) index and recurrence of atrial fibrillation after catheter ablation in heart failure patients with preserved ejection fraction (HFpEF), and to explore a new risk stratification index for atrial fibrillation recurrence. Methods This study is based on a prospective, multicenter Chinese atrial fibrillation registry, which included 413 atrial fibrillation patients who underwent catheter ablation for the first time between August 2011 and December 2020 and met the diagnostic criteria for HFpEF. TyG index was calculated by comparing baseline triglycerides with fasting plasma glucose. The primary outcome was recurrence of atrial fibrillation after a 90d blank-period. Patients were stratified according to the first and third quartiles of TyG index (Q1: 8.44, Q3: 8.96) and divided into low TyG index group (TyG index<8.44, 137 cases), medium TyG index group(TyG index 8.44-8.96, 139 cases), and high TyG index group (TyG index>8.96, 137 cases). Kaplan-Meier survival analysis and multivariate adjusted Cox proportional hazards regression model were used to evaluate the association between TyG index and atrial fibrillation recurrence. Results The average age of 413 patients was (61±11)years old, and 253 cases (61.3%) were male. During a median follow-up of 810 d, 256 cases (62.0%) developed recurrent atrial fibrillation events. Each one-standard-deviation increase in the TyG index was associated with a 29% higher risk of atrial fibrillation recurrence ［adjusted hazard ratio (HR)=1.29, 95% confidence interval (CI): 1.07-1.55, P=0.007］. Restricted cubic spline model analysis showed that TyG index had a dose-response relationship with the risk of recurrence. Compared with the low TyG index group, patients in the medium and high TyG index group had a 74% (adjusted HR=1.74, 95% CI: 1.21-2.50, P=0.003) and 106% (adjusted HR=2.06, 95% CI: 1.36-3.13, P=0.001) increased risk of recurrence, respectively (P for trend=0.001). Conclusions In atrial fibrillation patients with HFpEF, elevated TyG index is associated with a significantly increased risk of atrial fibrillation recurrence after catheter ablation, and there is a dose-response relationship. TyG index, as an economic and practical indicator of insulin resistance, can be used to guide the risk stratification and individualized management of recurrence in this population.