[1]陈坤 安慧 齐鹏 王贤 谷剑 陈淑霞.预后营养指数对冠心病合并2型糖尿病患者近期主要不良心血管事件的评估价值[J].心血管病学进展,2025,(1):77.[doi:10.16806/j.cnki.issn.1004-3934.2025.01.017]
　CHEN Kun,AN Hui,QI Peng,et al.The Value of Prognostic Nutritional Index in Assessing Recent Major Adverse Cardiovascular Events in Patients with Coronary Heart Disease combined with Type 2 Diabetes Mellitus[J].Advances in Cardiovascular Diseases,2025,(1):77.[doi:10.16806/j.cnki.issn.1004-3934.2025.01.017]
点击复制

预后营养指数对冠心病合并2型糖尿病患者近期主要不良心血管事件的评估价值()
分享到：

《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2025年1期
页码:
77
栏目:
论著
出版日期:
2025-01-25

文章信息/Info

Title:
The Value of Prognostic Nutritional Index in Assessing Recent Major Adverse Cardiovascular Events in Patients with Coronary Heart Disease combined with Type 2 Diabetes Mellitus
作者:
陈坤1; 2 安慧2 齐鹏2 王贤2 谷剑1; 2 陈淑霞1; 2
(1.河北北方学院研究生院,河北 张家口075000;2.河北省人民医院心血管内科,河北 石家庄 050051)
Author(s):
CHEN Kun1; 2; AN Hui2; QI Peng 2; WANG Xian2; GU Jian1; 2; CHEN Shuxia1; 2
(1.Graduate School of Hebei North College,Zhang Jiakou 075000,He Bei,China2.Department of Cardiovascular Medicine,Hebei Provincial Peoples Hospital,Shi Jiazhuang 050051,He Bei,China)
关键词:
冠心病; 2型糖尿病; 预后营养指数; 主要不良心血管事件; 评估价值
Keywords:
Coronary heart disease;  Type 2 diabetes mellitus;  Prognostic nutritional index;  Major adverse cardiovascular events;  A ssessment value
DOI:
10.16806/j.cnki.issn.1004-3934.2025.01.017
摘要:
目的 探讨预后 营养指数（PNI）对冠心病合并2型糖尿病患者近期主要不良心血管事件（MACE）的评估价值。方法 收集2 022年1月—2023年1月河北省人民医院心血管内科住院的391例冠心病合并2型糖尿病患者的临床资料进行回顾性分析，随访1年，根据有无MACE发生分为MACE组(n=99)与非MACE组(n=292)，比较两组一般资料，采用单因素和多因素Cox回归分析探索冠心病合并2型糖尿病患者近期发生MACE的影响因素。绘制受试者工作特征曲线分析PNI对近期MACE发生的预测价值，并计算曲线下面积。绘制PNI与冠心病合并2型糖尿病患者MACE发生风险相关性的限制性立方样条。绘制Kaplan-Meier曲线探索PNI对近期MACE发生的风险。采用Spearman秩相关分析PNI与心血管疾病危险因素的相关性。结果 多因素Cox回归分析示，PNI、空腹血糖、糖化血红蛋白、血小板/淋巴细胞比值、脂蛋白(a)是冠心病合并2型糖尿病患者发生MACE的独立影响因素 ( P＜0.05)，PNI预测冠心病合并2型糖尿病患者近期发生MACE的AUC为0.755（95% CI 0.698～0.811），限制性立方样条显示，PNI与MACE发生风险呈线性负相关(P非线性=0.800)。此外，PNI与MACE的相关性在不同亚组中一致。相关性分析示，PNI与体重指数、左室射血分数、肾小球滤过率、淋巴细胞呈正相关（P＜0.05）；PNI与年龄、D-二聚体、脂蛋白(a)、血小板/淋巴细胞比值、中性粒细胞/淋巴细胞比值呈负相关（P＜0.05）；Kaplan-Meier生存曲线显示，高PNI组发生MACE风险低于低PNI组，存在统计学差异(Wald?=25.666，PLog Rank＜0.001)。结论 PNI是冠心病合并2 型糖尿病患者近期发生MACE的独立影响因素，对临床工作者早期预防冠心病合并2型糖尿病患者MACE的发生具有一定的指导意义。
Abstract:
Objective To explore the value of prognostic nutritional index (PNI) in assessing recent major adverse cardiovascular events (MACE) in patients with coronary heart disease ( CHD) combined with type 2 diabetes mellitus (T2DM). Methods The clinical data of 391 patients with CHD combined with T2DM who were hospitalised in the Department of Cardiovascular Medicine of Hebei Provincial People’s Hospital from January 2022 to January 2023 were collected for retrospective analysis,followed up for 1 year,and divided into the MACE group (n=99) and the non-MACE group (n=292) according to the presence or absence of the occurrence of MACE,and the general data of the two groups were compared,and the one-way and multifactorial Cox regression analyses were used to explore the factors influencing the recent occurrence of MACE in patients with CHD combined with T2DM. The predictive value of PNI on the occurrence of recent MACE was analysed by plotting the receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC). Restricted cubic spline(RCS) of the sub-risk correlation between PNI and MACE occurrence in patients with CHD combined with T2DM were plotted. Kaplan-Meier curves were plotted to explore the risk of PNI on the occurrence of recent MACE. Spearman rank correlation was used to analyse the association between PNI and cardiovascular disease risk factors. Results The multifactorial Cox regression analysis found that P NI,fasting blood glucose,glycosylated hemoglobin,platelet count to lymphocyte count ratio and Lp(a) wer e independent influencing factors for the occurrence of MACE in patients with CHD combined with T2DM (P＜0.05),and the AUC of PNI for predicting the recent occurrence of MACE in patients with CHD combined with T2DM was 0.755 (95% CI 0.698～0.811),and RCS showed that PNI was linearly and negatively associated with the risk of developing MACE (Pnonlinear=0.800). Furthermore,the correlation between PNI and MACE was consistent across subgroups. Correlation analysis showed that PNI was positively correlated with body mass index,left ventricular ejection fraction,estimated glomerular filtration rate and lymphocyte ( P＜0.05);PNI was negatively correlated with age,D-dimer,Lp(a),platelet count to lymphocyte count ratio and neutrophil to lymphocyte ratio (P＜0.05); and Kaplan-Meier survival curves showed that the risk of developing MACE in the high-PNI group was lower than that of the low PNI group,which was statistically different (Wald?=25.666，PLog Rank＜0.001). Conclusion PNI is an independent influence on the recent occurrence of MACE in patients with CHD combined with T2DM and is clinically relevant in identifying the occurrence of MACE in this group of patients

参考文献/References:

[1] Bao J. Weighted gene coexpression network analysis identifies crucial genes involved in coronary atherosclerotic heart disease[J]. Dis Markers,2022,2022:6971238.

[2] Chitsazan M,Chitsazan M. The role of free fatty acids as a prognostic biomarker in coronary artery disease patients with type 2 diabetes[J]. Eur J Prev Cardiol,2023,30(8):728-729.

[3] Adela R,Reddy P,Ghosh TS,et al. Serum protein signature of coronary artery disease in type 2 diabetes mellitus[J]. J Transl Med,2019,17(1):17.

[4] Hu Y,Cao Q,Wang H,et al. Prognostic nutritional index predicts acute kidney injury and mortality of patients in the coronary care unit[J]. Exp Ther Med,2021,21(2):123.

[5] Kim HR,Kang MG,Kim K,et al. Comparative analysis of three nutrition scores in predicting mortality after acute myocardial infarction[J]. Nutrition,2021,90:111243.

[6] Zhang J,Chen Y,Zou L,et al. Prognostic nutritional index as a risk factor for diabetic kidney disease and mortality in patients with type 2 diabetes mellitus[J]. Acta Diabetol,2023,60(2):235-245.

[7] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华内分泌代谢杂志,2021,37(4):311-398.

[8] Chen H,Li B,Xiao Y,et al. Diagnostic efficacy of the optical flow ratio in patients with coronary heart disease:a meta-analysis[J]. PLoS One ,2023,18(5):e285508.

[9] Dong X,Li N,Zhu C,et al. Diagnosis of coronary artery disease in patients with type 2 diabetes mellitus based on computed tomography and pericoronary adipose tissue radiomics:a retrospective cross-sectional study[J]. Cardiovasc Diabetol,2023,22(1):14.

[10] Chen J,Yin D,Dou K. Intensified glycemic control by HbA1c for patients with coronary heart disease and Type 2 diabetes:a review of findings and conclusions[J]. Cardiovasc Diabetol,2023,22(1):146.

[11] Jin Y,Xu Z,Zhang Y,et al. Serum/plasma biomarkers and the progression of cardiometabolic multimorbidity:a systematic review and meta-analysis[J]. Front Public Health,2023,11:1280185.

[12] Ward NC,Vickneswaran S,Watts GF. Lipoprotein (a) and diabetes mellitus:causes and consequences[J]. Curr Opin Endocrinol Diabetes Obes,2021,28(2):181-187.

[13] Joshi A,Bhambhani A,Barure R,et al. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as markers of stable ischemic heart disease in diabetic patients:an observational study[J]. Medicine (Baltimore),2023,102(5):e32735.

[14] 梅超生,闵轩. 血常规衍生复合炎症指标在冠心病患者中研究进展[J]. 中国心血管病研究,2023,21(12):1145-1150.

[15] Chang WT,Sun CK,Wu JY,et al. Association of prognostic nutritional index with long-term mortality in patients receiving percutaneous coronary intervention for acute coronary syndrome:a meta-analysis[J]. Sci Rep,2023,13(1):13102.

[16] Chen JJ,Lee TH,Lai PC,et al. Prognostic nutritional index as a predictive marker for acute kidney injury in adult critical illness population:a systematic review and diagnostic test accuracy meta-analysis[J]. J Intensive Care,2024,12(1):16.

[17] Li T,Yuan D,Wang P,et al. Association of prognostic nutritional index level and diabetes status with the prognosis of coronary artery disease:a cohort study[J]. Diabetol Metab Syndr,2023,15(1):58.

[18] 赵帮豪,袁腾,赵翎,等. 预后营养指数与急性ST段抬高型心肌梗死合并2型糖尿病患者经皮冠状动脉介入术后院内主要不良心血管事件关系的研究[J]. 中国全科医学,2024,27(15):1817-1824.

[19] Wada H,Dohi T,Miyauchi K,et al. Relationship between the prognostic nutritional index and long-term clinical outcomes in patients with stable coronary artery disease[J]. J Cardiol,2018,72(2):155-161.

[20] Manolis AA,Manolis TA,Melita H,et al. Low serum albumin:a neglected predictor in patients with cardiovascular disease[J]. Eur J Intern Med ,2022,102:24-39.

[21] Arques S. Serum albumin and cardiovascular disease:does low serum albumin contribute to the emergence and worsening of some cardiovascular diseases?[J]. Eur J Intern Med,2020,80:122-123.

[22] Ronit A,Kirkegaard-Klitbo DM,Dohlmann TL,et al. Plasma albumin and incident cardiovascular disease:results from the CGPS and an updated meta-analysis[J]. Arterioscler Thromb Vasc Biol,2020,40(2):473-482.

[23] Rajamanickam A,Munisankar S,Dolla CK,et al. Impact of malnutrition on systemic immune and metabolic profiles in type 2 diabetes[J]. BMC Endocr Disord,2020,20(1):168.

[24] Cardoso C,Leite NC,Salles GF. Importance of hematological parameters for micro- and macrovascular outcomes in patients with type 2 diabetes:the Rio de Janeiro type 2 diabetes cohort study[J]. Cardiovasc Diabetol,2021,20(1):133.

[25] Zafrir B,Hussein S,Jaffe R,et al. Lymphopenia and mortality among patients undergoing coronary angiography:long-term follow-up study[J]. Cardiol J,2022,29(4):637-646.

相似文献/References:

[1]杜钧,佘强.冠心病抗炎治疗的临床研究进展[J].心血管病学进展,2016,(1):32.[doi:10.16806/j.cnki.issn.1004-3934.2016.01.009]
　DU Jun,SHE Qiang.Clinical Research Progress of Anti-inflammatory Therapy of Coronary Heart Disease[J].Advances in Cardiovascular Diseases,2016,(1):32.[doi:10.16806/j.cnki.issn.1004-3934.2016.01.009]
[2]努热曼古丽·阿布都克热木,马依彤.重度左心室收缩功能不全的冠心病患者血运重建治疗疗效及预后的评价[J].心血管病学进展,2016,(1):46.[doi:10.16806/j.cnki.issn.1004-3934.2016.01.012]
　NUREMANGULI·Abudukeremu,MA Yitong.Evaluation of Efficacy and Prognosis of Revascularization Therapy on Patients with Coronary Heart Disease and Severe Left Ventricular Systolic Dysfunction[J].Advances in Cardiovascular Diseases,2016,(1):46.[doi:10.16806/j.cnki.issn.1004-3934.2016.01.012]
[3]刘洋,综述,伍贵富,等.增强型体外反搏治疗冠心病的新机制[J].心血管病学进展,2016,(2):185.[doi:10.16806/j.cnki.issn.1004-3934.2016.02.023]
　LIU Yang,WU Guifu.New Mechanism of Enhanced External Counterpulsation for Treatment of Coronary Artery Disease[J].Advances in Cardiovascular Diseases,2016,(1):185.[doi:10.16806/j.cnki.issn.1004-3934.2016.02.023]
[4]杨洋,综述,沈比先,等.心脏核磁共振评估缺血性心脏病的应用价值[J].心血管病学进展,2016,(2):204.[doi:10.16806/j.cnki.issn.1004-3934.2016.02.028]
　YANG Yang,SHEN Bixian.Value of Cardiac Magnetic Resonance Assessment of Ischemic Heart Disease[J].Advances in Cardiovascular Diseases,2016,(1):204.[doi:10.16806/j.cnki.issn.1004-3934.2016.02.028]
[5]史敬,综述,马依彤,等.n-3多不饱和脂肪酸对心血管疾病的临床应用[J].心血管病学进展,2016,(3):278.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.016]
　SHI Jing,MA Yitong.Effects of n-3 Polyunsaturated Fatty Acids on Cardiovascular Disease[J].Advances in Cardiovascular Diseases,2016,(1):278.[doi:10.16806/j.cnki.issn.1004-3934.2016.03.016]
[6]高柳,袁晋青.重复支架置入术治疗药物洗脱支架再狭窄的研究进展[J].心血管病学进展,2015,(5):555.[doi:10.3969/j.issn.1004-3934.2015.05.008]
　GAO Liu,YUAN Jingqing.Progress in Treatment for Drug-eluting Stent Restenosis by Re-implementation of Stents[J].Advances in Cardiovascular Diseases,2015,(1):555.[doi:10.3969/j.issn.1004-3934.2015.05.008]
[7]邓文政,邓平.MG53蛋白的研究进展[J].心血管病学进展,2015,(5):626.[doi:10.3969/j.issn.1004-3934.2015.05.027]
　DENG Wenzheng,DENG Ping.Research Progress of MG53[J].Advances in Cardiovascular Diseases,2015,(1):626.[doi:10.3969/j.issn.1004-3934.2015.05.027]
[8]陈静,李兴德.冠心病患者服药依从性的研究进展[J].心血管病学进展,2015,(6):728.[doi:10.3969/j.issn.1004-3934.2015.06.018]
　CHEN Jing,LI Xingde.Advances in Medication Adherence of Patients with Coronary Heart Disease[J].Advances in Cardiovascular Diseases,2015,(1):728.[doi:10.3969/j.issn.1004-3934.2015.06.018]
[9]姚雯,毛露,孙硕,等.心源性外泌体作为冠心病标志物和新靶点展望[J].心血管病学进展,2019,(6):844.[doi:10.16806/j.cnki.issn.1004-3934.2019.06.002]
　YAO Wen,MAO Lu,SUN Shuo,et al.Exogenous Exosome as A New Marker and Target of Coronary Heart Disease[J].Advances in Cardiovascular Diseases,2019,(1):844.[doi:10.16806/j.cnki.issn.1004-3934.2019.06.002]
[10]郭彩艳 靳春荣.腺苷药物在心血管疾病诊治中的应用进展[J].心血管病学进展,2019,(7):1011.[doi:10.16806/j.cnki.issn.1004-3934.2019.07.012]
　GUO CaiyanJIN Chunrong.Progress in the Application of Adenosine Drugs in the Diagnosis and Treatment of Cardiovascular Diseases[J].Advances in Cardiovascular Diseases,2019,(1):1011.[doi:10.16806/j.cnki.issn.1004-3934.2019.07.012]
[11]张甜甜 安军 李伟 凌宏威 李树法.2型糖尿病合并冠心病患者小而密低密度脂蛋白与其冠状动脉病变严重程度的相关性研究[J].心血管病学进展,2021,(5):470.[doi:10.16806/j.cnki.issn.1004-3934.2021.05.020]
　ZHANG Tiantian,AN Jun,LI Wei,et al.Correlation Between Small and Dense Low Density Lipoprotein and Severity of Coronary Artery Disease in Patients with Type 2 Diabetes Mellitus Complicated with Coronary Heart Disease[J].Advances in Cardiovascular Diseases,2021,(1):470.[doi:10.16806/j.cnki.issn.1004-3934.2021.05.020]

更新日期/Last Update: 2025-02-26