2026 年第 5 期 第 21 卷

C反应蛋白-甘油三酯-葡萄糖指数与急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后主要不良心脑血管事件的关系

Relationship between C-reactive protein-triglyceride-glucose index and major adverse cardiovascular and cerebrovascular events after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

作者：王龙飞陈永增金泽宁韩静

英文作者：Wang Longfei Chen Yongzeng Jin Zening Han Jing

单位：首都医科大学附属北京天坛医院心脏及大血管病中心，北京100070

英文单位：Department of Cardiology and Macrovascular Disease Beijing Tiantan Hospital Capital Medical University Beijing 100070 China

关键词：急性ST段抬高型心肌梗死；经皮冠状动脉介入；C反应蛋白-甘油三酯-葡萄糖指数；主要不良心脑血管事件

英文关键词：AcuteST-segmentelevationmyocardialinfarction;Percutaneouscoronaryintervention;C-reactiveprotein-triglyceride-glucoseindex;Majoradversecardiovascularandcerebrovascularevents

• 摘要：

• 目的 探讨C反应蛋白-甘油三酯-葡萄糖指数（CTI）对急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）术后主要不良心脑血管事件（MACCE）的预测价值。方法 回顾性选取2022年10月至2024年10月于首都医科大学附属北京天坛医院行急诊PCI的431例STEMI患者为研究对象。根据CTI三分位数将患者分为低CTI组（CTI＜5.01，144例）、中CTI组（5.01≤CTI＜5.56，143例）、高CTI组（CTI≥5.56，144例）。收集患者人口统计学、既往病史、实验室检查及介入手术相关资料，中位随访时间为28个月，主要终点为MACCE发生。分析不同CTI组的无MACCE生存率，利用Cox比例风险回归模型评估CTI与MACCE的关联，借助限制性立方样条（RCS）分析二者的剂量-反应关系，并开展亚组交互分析。结果 生存分析显示低CTI组MACCE发生率显著低于中、高CTI组（P=0.039）。Cox回归分析显示，调整多种混杂因素后，CTI作为连续变量每升高1个单位，患者MACCE发生风险增加59%（P=0.006）；中、高CTI组MACCE风险分别为低CTI组的1.94倍（P=0.032）和2.08倍（P=0.018）。RCS曲线提示CTI与MACCE风险呈正相关，但没有显著非线性关联（P整体=0.022，P非线性=0.898）。亚组分析显示，高血压病史与 CTI 存在显著交互作用（P=0.002），在有高血压病史的患者中，CTI升高与 MACCE风险的关联更强（风险比=3.51，P＜0.001），而无高血压病史患者中该关联不显著。结论 CTI水平与STEMI患者急诊PCI术后MACCE的发生相关，可作为临床评估患者预后风险的参考指标。

• Objective To investigate the predictive value of C-reactive protein-triglyceride-glucose index (CTI) for major adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods A total of 431 STEMI patients who underwent emergency PCI in Beijing Tiantan Hospital, Capital Medical University from October 2022 to October 2024 were retrospectively enrolled. According to tertiles of CTI, patients were divided into low CTI group (CTI<5.01, 144 cases), middle CTI group (5.01≤CTI<5.56, 143 cases) and high CTI group (CTI≥5.56, 144 cases). Demographic data, past medical history, laboratory examinations and interventional procedure-related data were collected. The median follow-up time was 28 months, and the primary endpoint was the occurrence of MACCE. MACCE-free survival rates among different CTI groups were analyzed. Cox proportional hazards regression model was used to evaluate the association between CTI and MACCE. Restricted cubic spline (RCS) was applied to analyze the dose-response relationship, and subgroup interaction analysis was performed. Results Survival analysis showed that the incidence of MACCE in the low CTI group was significantly lower than that in the middle and high CTI groups (P=0.039). Cox regression analysis revealed that after adjustment for multiple confounders, each 1-unit increase in CTI as a continuous variable was associated with a 59% increased risk of MACCE (P=0.006); the risks of MACCE in the middle and high CTI groups were 1.94 times (P=0.032) and 2.08 times (P=0.018) that in the low CTI group, respectively. RCS curve indicated a positive correlation between CTI and MACCE risk without significant nonlinearity (Poverall=0.022, Pnonlinear=0.898). Subgroup analysis showed a significant interaction between hypertension history and CTI (P=0.002). The association between elevated CTI and higher MACCE risk was stronger in patients with hypertension (hazard ratio=3.51, P<0.001), but not significant in those without hypertension. Conclusion CTI level is associated with the occurrence of MACCE in STEMI patients after emergency PCI, and can be used as a reference index for clinical evaluation of prognostic risk.