摘要
背景三酰甘油-葡萄糖(TyG)指数作为胰岛素抵抗(IR)的替代指标,与代谢综合征及肺栓塞(PE)的发病机制相关。目的探究TyG指数与重症PE患者临床预后之间的关联。方法本研究为回顾性队列研究,数据来源于重症监护医学信息数据库(MIMIC-Ⅳ)。选取该数据库中2008—2019年入住重症监护病房(ICU)的PE患者,根据其入ICU首日的TyG指数四分位数将患者分为4组。主要结局指标为住院期间的全因死亡率,包含住院死亡率和ICU死亡率。通过Cox比例风险回归分析和限制性立方样条(RCS)探索TyG指数与患者预后的关系。结果本研究共纳入391例患者,平均年龄为(62.2±16.5)岁。整个队列的平均TyG指数为(4.95±0.41)。观察到住院死亡率为19.18%(75/391),ICU内死亡率为10.23%(40/391)。根据入院时的TyG指数,将患者分为4个四分位组(TyG指数分别为Q1:3.81~4.68;Q2:4.69~4.90;Q3:4.91~5.18;Q4:5.19~7.05),分别为98、97、98、98例。调整自变量后Cox比例风险回归分析结果显示:随着TyG指数升高,PE患者住院死亡风险(HR=4.14,95%CI=1.40~12.28,P=0.010)、ICU死亡风险(HR=6.45,95%CI=1.27~32.60,P=0.024)均增加。相较于Q1,TyG指数位于Q4的PE患者住院死亡风险增加(HR=4.17,95%CI=1.33~13.03,P=0.014)。RCS结果显示,随着TyG指数的升高,住院死亡率和ICU死亡率呈线性增加(P非线性值分别为0.833、0.669)。结论重症PE患者的全因死亡率与TyG指数之间存在显著关联,提示TyG指数可作为预测住院及ICU死亡风险有价值的指标。
Background The triglyceride-glucose(TyG)index,a surrogate marker of insulin resistance(IR),is associated with the pathogenesis of metabolic syndrome and pulmonary embolism(PE).Objective To investigate the association between the TyG index and clinical outcomes in critically ill patients with PE.Methods This retrospective cohort study utilized data from the Medical Information Mart for Intensive CareⅣ(MIMIC-Ⅳ)database.PE patients admitted to the intensive care unit(ICU)between 2008 and 2019 were included.Patients were divided into four groups according to the quartiles of their TyG index on the first day of ICU admission.The primary outcome was all-cause mortality during hospitalization,including in-hospital mortality and ICU mortality.The association between the TyG index and patient prognosis was assessed using Cox proportional hazards regression analysis and restricted cubic splines(RCS).Results A total of 391 patients were included in the study,with a mean age of(62.2±16.5)years.The average TyG index of the entire cohort was(4.95±0.41).The observed in-hospital mortality rate was 19.18%(75/391),while the ICU mortality rate was 10.23%(40/391).Based on the TyG index at admission,patients were divided into four quartile groups(TyG index:Q1:3.81-4.68,Q2:4.69-4.90,Q3:4.91-5.18,and Q4:5.19-7.05),with 98,97,98,and 98 patients in each group,respectively.After adjusting for covariates,Cox proportional hazards regression analysis showed that an increasing TyG index was associated with a higher risk of in-hospital mortality(HR=4.14,95%CI=1.40-12.28,P=0.010)and ICU mortality(HR=6.45,95%CI=1.27-32.60,P=0.024).Compared to Q1,Q4 TyG quartile had a significantly increased risk of in-hospital mortality(HR=4.17,95%CI=1.33-13.03,P=0.014).RCS analysis indicated a linear increase in both in-hospital and ICU mortality rates with higher TyG index levels(Pfor nonlinearity=0.833 and 0.669,respectively).Conclusion There is a significant association between the TyG index and all-cause mortality in critically ill PE patients,suggesting that the TyG index may serve as a valuable predictor of in-hospital and ICU mortality risk.
作者
米凌玉
陈连鑫
高恒波
王彬成
MI Lingyu;CHEN Lianxin;GAO Hengbo;WANG Bincheng(Fuwai Hospital,National Center for Cardiovascular Diseases,National Clinical Research Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiovascular Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,National Clinical Research Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Emergency,the Second Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Neurology,Fuwai Hospital,National Center for Cardiovascular Diseases,National Clinical Research Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)
出处
《中国全科医学》
北大核心
2025年第35期4421-4429,共9页
Chinese General Practice
基金
2023年吴阶平医学基金会临床科研专项资助基金(320.6750.2022-26-12)。
作者简介
通信作者:王彬成,主治医师,E-mail:1352521527@qq.com。
