胰岛素抵抗代谢评分与慢性心力衰竭患者不良预后的相关性研究
orrelation between Insulin Resistance Metabolic Score and Poor Prognosis in Patients with Chronic Heart Failure
背景 胰岛素抵抗（IR）与心血管疾病的发生、发展关系密切，目前多项研究已经证实了 IR 在心力衰竭（HF）患者中非常普遍，并与不良心血管结局有关，而反映 IR 的指标——胰岛素抵抗代谢评分（Mets-IR）与慢性心力衰竭（CHF）患者不良预后之间的关联目前尚不清楚。目的 分析 Mets-IR 与 CHF 患者不良预后之间的相关性。方法 本研究为回顾性研究，选取 2020 年 1 月—2021 年 1 月在郑州大学第二附属医院心血管内科确诊为 CHF 的患者313 例为研究对象。根据是否发生全因死亡将患者分为两组：全因死亡组（61 例）和对照组（252 例）。将 Mets-IR作为分类变量进行分析，以中位数将 Mets-IR 分为两类：低水平 Mets-IR（Mets-IR<37.28）和高水平 Mets-IR（MetsIR ≥ 37.28）。收集患者基线资料，其中包括 Mets-IR 及其年龄、血清生物标志物和超声心动图指标，随访截至 2022-12-31。通过本院电子病历系统或电话随访收集患者预后情况，主要终点事件为全因死亡，次要终点事件为因 HF 再入院。不同水平 Mets-IR 患者全因死亡及因 HF 再入院的生存曲线采用 Kaplan-Meier 图和 Log-rank 检验进行分析。应用 Cox比例风险回归模型分析 Mets-IR 与全因死亡及因 HF 再入院风险的相关性。构建受试者工作特征（ROC）曲线，分析Mets-IR 对 CHF 患者全因死亡及因 HF 再入院风险的预测价值。结果 中位随访时间 25.0（9.0，28.5）个月，313 例CHF 患者中出现全因死亡 61 例（19.5%）、因 HF 再入院 121 例（38.7%）。全因死亡组患者年龄、空腹血糖、MetsIR、N 末端 B 型钠尿肽前体、血尿酸、中性粒细胞计数、红细胞分布宽度、心房颤动、高血压、利尿剂、醛固酮受体拮抗剂、美国纽约心脏病学会（NYHA）分级高于对照组，舒张压、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、白蛋白、血红蛋白、血钠、左心室射血分数、血管紧张素转化酶抑制剂（ACEI）/ 血管紧张素受体拮抗剂（ARB）/ 血管紧张素受体 - 脑啡肽酶抑制剂（ARNI）低于对照组（P<0.05）。Log-rank 检验结果显示，高水平 MetsIR 患者的全因死亡率及因 HF 再入院率均高于低水平 Mets-IR 患者（P<0.001）。调整多个混杂因素后的 Cox 比例风险回归分析结果显示，与低水平 Mets-IR 患者相比，高水平 Mets-IR 患者全因死亡风险（HR=2.90，95%CI=1.51~5.54，P=0.001）、因 HF 再入院风险（HR=1.55，95%CI=1.04~2.30，P=0.030）均升高。Mets-IR 预测全因死亡风险、因 HF再入院风险的 ROC 曲线下面积分别为 0.68（95%CI=0.62~0.75）、0.62（95%CI=0.55~0.68）。结论 Mets-IR 水平升高可能会增加 CHF 患者的全因死亡及因 HF 再入院风险，可用于 CHF 患者的危险分层。
BackgroundInsulin resistanceIRis closely related to the development and progression of cardiovascular diseaseand several studies have now demonstrated that IR is highly prevalent in patients with heart failureHFand is associated with adverse cardiovascular outcomeswhereas the association between the Metabolic Score of Insulin ResistanceMets-IRan indicator reflecting IRand the poor prognosis in patients with chronic heart failureCHFis currently unknown. ObjectiveTo analyse the correlation between Mets-IR and poor prognosis in patients with CHF. MethodsThis was a retrospective studyand 313 patients who were diagnosed with CHF in the Department of Cardiovascular Medicine of the Second Affiliated Hospital of Zhengzhou University from January 2020 to January 2021 were selected as study subjects. The patients were divided into two groups according to whether all-cause mortality occurredthe all-cause mortality group61 casesand the control group252 cases. Mets-IR was analysed as a categorical variableand Mets-IR was classified into two categories by medianlow level Mets-IRMets-IR<37.28and high level Mets-IRMets-IR 37.28. Patients' baseline datawhich included Mets-IR and their ageserum biomarkers and echocardiographic indiceswere collected and followed up until 2022-12-31and patients' prognosis was collected through our electronic medical record system or telephone follow-upwith the primary endpoint event being all-cause mortality and the secondary endpoint event being readmission for HF. Survival curves for all-cause death and readmission due to HF in patients with different levels of Mets-IR were analysed using KaplanMeier plots and Log-rank tests. Cox proportional risk regression model was applied to analyse the correlation between Mets-IR and the risk of all-cause death and readmission due to HF. Subject work characteristicsROCcurves were constructed to analyse the predictive value of Mets-IR for the risk of all-cause mortality and readmission due to HF in CHF patients. ResultsAt a median follow-up of 25.09.028.5months6119.5%all-cause deaths and 12138.7%readmissions for HF occurred in 313 CHF patients.Patients in the all-cause mortality group had higher agefasting glucoseMets-IRN-terminal B-type natriuretic peptide precursorblood uric acidneutrophil counterythrocyte distribution widthatrial fibrillationhypertensiondiureticsaldosterone receptor antagonistand New York Heart AssociationNYHAclassification than controlsand diastolic blood pressuretriacylglycerolhigh-density lipoproteinHDLcholesteroland low-density lipoprotein cholesterolalbuminhaemoglobinblood sodiumleft ventricular ejection fractionand angiotensin-converting enzyme inhibitorACEI/angiotensin receptor antagonistARB/angiotensin receptor-enkephalinase inhibitorARNIwere lower than those of the control groupP<0.05.The results of the log-rank test showed that the all-cause mortality rate and the readmission rate due to HF were both higher in the patients with high-level Mets-IR than those with low-level Mets-IRP<0.001. Cox proportional risk regression analysis after adjusting for several confounders showed that compared with low-level Mets-IR patientshighlevel Mets-IR patients had higher risks of all-cause mortalityHR=2.9095%CI=1.51-5.54P=0.001and readmission for HFHR=1.5595%CI=1.04-2.30P=0.030. The area under the ROC curve for Mets-IR to predict the risk of all-cause mortality and the risk of readmission due to HF were 0.6895%CI=0.62-0.75and 0.6295%CI=0.55-0.68. ConclusionElevated Mets-IR levels may increase the risk of all-cause mortality and readmission due to HF in patients with CHFand can be used for risk stratification of CHF patients.
阴秋果、简立国、张议丹、秦欣童、姜鹏、郭平、贾兴泰
10.12114/j.issn.1007-9572.2023.0892
内科学临床医学基础医学
慢性心力衰竭胰岛素抵抗代谢评分全因死亡因心力衰竭再入院不良预后回顾性研究ox 比例风险回归
阴秋果,简立国,张议丹,秦欣童,姜鹏,郭平,贾兴泰.胰岛素抵抗代谢评分与慢性心力衰竭患者不良预后的相关性研究[EB/OL].(2024-03-11)[2025-08-03].https://chinaxiv.org/abs/202403.00199.点此复制
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