Correlation of prognostic nutritional index, γ-glutamyltransferase/albumin ratio and short-term prognosis in elderly patients with acute coronary syndrome
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摘要: 目的 探究预后营养指数(PNI)、γ-谷氨酰转移酶/白蛋白比值(GAR)与老年急性冠脉综合征患者短期预后的相关性。方法 选择2017年1月—2019年12月期间在我院行经皮冠状动脉介入治疗(PCI)的老年急性冠脉综合征患者120例(观察组)。另选这一时期内体检健康志愿者100例(对照组)。检测比较两组外周血PNI、GAR水平差异。随访1年，根据患者有无不良心血管事件发生(MACE)，将其分为MACE组(28例)与非MACE组(92例)，详细记录患者病历资料如血脂指标、心功能指标等。采用多因素logistics回归分析影响急性冠脉综合征患者MACE发生的危险因素。应用ROC曲线分析PNI、GAR对急性冠脉综合征患者MACE发生的预测价值。结果 观察组外周血PNI、GAR值与对照组外周血PNI、GAR值相比，差异有统计学意义(P < 0.05)。MACE组外周血PNI值低于非MACE组，GAR值高于非MACE组，差异有统计学意义(P < 0.05)。多因素logistics回归分析示，Gensini评分升高、PNI降低及GAR升高是急性冠脉综合征患者MACE发生的独立危险因素(P < 0.05)。ROC曲线结果示，PNI、GAR及二者结合预测急性冠脉综合征患者MACE发生的AUC分别为0.767、0.801、0.906，敏感度分别为0.791、0.806、0.687，特异度分别为0.652、0.609、0.913。结论 入院时外周血PNI降低、GAR升高与急性冠脉综合征的临床预后密切相关，早期联合检测PNI、GAR对判断急性冠脉综合征患者预后状况有较高参考价值。
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关键词:
- 预后营养指数 /
- γ-谷氨酰转移酶/白蛋白比值 /
- 急性冠脉综合征 /
- 预后
Abstract: Objective Toexplore the correlation between prognostic nutritional index(PNI), γ-glutamyltransferase/albumin ratio(GAR) and short-term prognosis in elderly patients with acute coronary syndrome.Methods A total of 120 elderly patients with acute coronary syndrome who underwent percutaneous coronary intervention(PCI) in our hospital from January 2017 to December 2019 were selected(observation group). Another 100 healthy volunteers(control group) were selected during this period. The differences in peripheral blood PNI and GAR levels between the two groups were detected and compared. Patients were followed up for 1 year. According to the occurrence of adverse cardiovascular events (MACE), patients were divided into MACE group (n=28) and non-MACE group (n=92). Medical records of patients were recorded in detail, such as blood lipid indicators, cardiac function indicators, etc. Multivariate logistic regression analysis was used to analyze the risk factors affecting the occurrence of MACE in patients with acute coronary syndrome. The ROC curve was used to analyze the predictive value of PNI and GAR for the occurrence of MACE in patients with acute coronary syndrome.Results The PNI and GAR values of peripheral blood in the observation group were significantly different from those in the control group(P < 0.05). The peripheral blood PNI value in the MACE group was lower than that of the non-MACE group, and the GAR value was higher than that of the non-MACE group, with a statistically significant differences(P < 0.05). Multivariate logistic regression analysis showed that increased Gensini score, decreased PNI and increased GAR were independent risk factors for MACE in patients with acute coronary syndrome(P < 0.05). The ROC curve results showed that the AUCs of PNI, GAR and their combination in predicting the occurrence of MACE in patients with acute coronary syndrome were 0.767, 0.801, and 0.906, respectively, with sensitivities of 0.791, 0.806, and 0.687, and specificities of 0.652, 0.609, and 0.913, respectively.Conclusion The decrease of peripheral blood PNI and the increase of GAR in peripheral blood on admission are closely related to the clinical prognosis of acute coronary syndrome. The early combined detection of PNI and GAR has a high reference value for judging the prognosis of patients with acute coronary syndrome. -
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表 1 观察组与对照组外周血PNI、GAR比较
x±S 组别 例数 PNI GAR 对照组 100 50.36±9.11 0.54±0.17 观察组 120 38.29±6.64 0.91±0.32 t 7.410 4.658 P < 0.001 < 0.001 
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表 2 MACE组与非MACE组临床资料及外周血PNI、GAR值比较
x±S，例(%) 指标 MACE组(28例) 非MACE组(92例) t/χ2 P 年龄/岁 70.25±11.49 68.76±8.42 0.393 0.682 性别 男 17(60.71) 51(55.43) 0.244 0.668 女 11(39.29) 41(44.57) BMI 24.41±2.36 23.94±2.05 0.627 0.391 吸烟史 有 15(53.57) 35(38.04) 2.130 0.189 无 13(46.43) 57(61.96) 饮酒史 有 12(42.86) 29(31.52) 1.226 0.363 无 16(57.14) 63(68.48) 高血压 有 17(60.72) 38(41.30) 3.258 0.056 无 11(39.28) 54(58.70) 糖尿病 有 9(32.14) 20(21.74) 1.268 0.314 无 19(67.86) 72(78.26) 急性冠脉综合征类型 不稳定性心绞痛 6(21.43) 35(38.04) 2.635 0.117 急性心肌梗死 22(78.57) 57(61.96) LVEF/% 48.10±5.22 57.19±6.83 6.297 < 0.001 Gensini评分/分 93.65±20.07 71.48±16.15 11.038 < 0.001 发病至PCI时间/h 6.87±1.99 6.23±2.04 0.594 0.461 Killip分级 Ⅰ~Ⅱ级 8(28.57) 62(67.39) 13.310 < 0.001 Ⅲ~Ⅳ级 20(71.43) 30(32.61) 术后TIMI血流分级 3级 22(78.57) 84(91.30) 3.377 0.091 0~2级 6(21.43) 8(8.70) 残余冠状动脉狭窄 有 4(14.29) 5(5.43) 2.424 0.211 无 24(85.71) 87(94.57) TC/(mmol·L-1) 4.12±1.19 4.03±0.82 0.475 0.523 TG/(mmol·L-1) 1.50±0.61 1.37±0.46 0.911 0.218 HDL-C/(mmol·L-1) 1.28±0.47 1.41±0.55 1.153 0.149 LDL-C/(mmol·L-1) 2.77±0.83 2.85±0.91 0.324 0.715 NT-proBNP/(ng·mL-1) 910.36±174.58 725.14±139.50 7.506 < 0.001 cTnT/(μg·L-1) 4.84±0.69 4.17±0.52 2.471 0.053 PNI 35.24±5.61 39.22±10.18 5.291 < 0.001 GAR 1.27±0.53 0.80±0.41 3.877 0.001 术后用药 阿司匹林 26(92.86) 88(95.65) 0.353 0.623 氯吡格雷 22(78.57) 79(85.87) 0.858 0.381 替格瑞洛 7(25.99) 15(16.30) 1.084 0.402 他汀类药物 26(92.86) 90(97.83) 1.645 0.232
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表 3 影响急性冠脉综合征患者MACE发生的多因素分析
指标 β SE P OR 95%CI LVEF -0.411 0.197 0.231 0.502 0.386~0.994 Gensini评分 0.436 0.215 0.005 1.478 1.052~4.615 Killip分级 0.509 0.243 0.116 1.391 1.007~3.528 NT-proBNP 0.383 0.170 0.184 2.015 1.439~5.176 PNI -0.457 0.228 0.001 0.372 0.245~0.839 GAR 0.291 0.103 0.001 1.546 1.118~5.024
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