没有传统心血管危险因素的CAD患者TyG指数与冠脉损伤和一年再入院的关系

栾慧; 王萍; 曹丽菲; 罗超迪; 郑婷婷; 白川; 朱丹军; 田刚

doi:10.12125/j.chj.202110065

没有传统心血管危险因素的CAD患者TyG指数与冠脉损伤和一年再入院的关系

Association of TyG index with coronary artery lesions and one-year re-admission in coronary artery disease patients without traditional cardiovascular risk factors

摘要

摘要:
目的探讨没有传统心血管危险因素(CVRF)的冠心病（coronary artery disease，CAD）患者甘油三酯葡萄糖（triglyceride glucose，TyG）指数与冠脉损伤及一年再入院的关系。
方法共分析了300例（60 ± 92）岁（男，71.3 %）无传统CVRF的冠心病患者， CVRF（传统标准）：收缩压/舒张压≥140/90 mmHg；空腹血糖≥1260 mg/L；总胆固醇≥2400 mg/L；低密度脂蛋白胆固醇≥1600 mg/L；高密度脂蛋白胆固醇<400 mg/L；体质量指数≥24.0 kg/m²；吸烟；既往有高血压、糖尿病和血脂异常病史。根据其TyG指数三分位数分为三组，横向对比了三组患者冠状动脉造影特征以及严重冠心病患病风险，并前瞻性地探讨了TyG指数与一年再入院发生的关系。
结果在没有传统 CVRF 的冠心病患者中，随着TyG指数的分位数增加，冠脉病变形态除了弥漫病变患病率没有趋势变化，左主干病变、三支病变、钙化病变、完全闭塞病变等复杂病变患病率逐渐增高，相邻组间统计学差异P <0.05，跨组统计学差异P <0.01。三组之间Gensini评分的差异具有统计学意义，随着TyG指数的分位数增加Gensini评分逐渐增高39 (20,59) vs. 47 (18,72) vs. 51 (20,109) , 相邻组间统计学差异P <0.05，跨组统计学差异P <0.01。以T1组作为参照，处于T3组的无传统CVRF的CAD患者患严重冠心病风险增加（OR＝2.62），校正潜在心血管危险因素后，风险依然存在，差异具有统计学意义（均 P <0.05）。前瞻性分析表明，随着TyG指数的分位数增加，一年再入院率增加（HR:2.57, 95% CI: 1.13~5.78）。在控制其他风险因素后，处于T3组的无传统CVRF的CAD患者一年再入院发生风险是处于T1组的无传统CVRF的CAD患者的近3倍。
结论在无传统CVRF的CAD患者中TyG指数水平升高的患者冠状动脉病变更严重，一年再入院的风险增加。

Abstract:
AIM To explore the association of triglyceride glucose (TyG) with the severity of cardiovascular diseases and one-year re-admission rate in coronary artery disease (CAD) patients without traditional cardiovascular risk factors (CVRFs).
METHODS The data of 300 CAD patients without CVRFs (60 ± 9 years, 71.3% male) were analyzed. The following were considered as traditional CVRFs: systolic/diastolic blood pressure ≥140/90 mmHg; fasting glucose ≥1260 mg/L; total cholesterol ≥2400 mg/L; low-density lipoprotein cholesterol (LDL-C) ≥1600 mg/L; high-density lipoprotein cholesterol <4000 mg/dL; body mass index ≥24.0 kg/m²; current smoking status; and previous medical history of hypertension, diabetes and dyslipidaemia. The subjects were assigned to three groups based on their TyG index tertiles. Their coronary angiography characteristics were analyzed in a cross-sectional study and the relationship between TyG index and one-year re-admission rate was prospectively explored.
RESULTS The cross-sectional analysis showed that in CAD patients without traditional CVRFs, the incidence of left main disease, three-vessel disease, calcification lesion, total occlusive lesion and complex lesion, as well as Gensini score was in the order of TyG index tertile 3 >TyG index tertile 2 > TyG index tertile . The statistical difference between adjacent groups was P <0.05, and the cross group statistical difference was P< 0.01. In addition, CAD patients without traditional CVRFs in the highest TyG index tertile group were at an increased risk of severe CAD (OR=2.62) and the correlation was still statistically significant even after adjusting for potential cardiovascular risk factors , The statistical difference between adjacent groups was P<0.05, and the cross group statistical difference was P<0.01. Prospective analyses showed that the higher the TyG index tertile was, the higher the one-year re-admission rate in CAD patients without traditional CVRFs. After adjusting for other risk factors, the one-year re-admission rate of patients in the highest TyG index tertile group was nearly 3 times more than that of patients in the lowest TyG index tertile group.
CONCLUSION CAD patients without traditional CVRFs have more severe coronary artery lesions and an increased risk of one-year re-admission rate.

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