入院血糖影响重症监护室急性冠状动脉综合征患者的预后——基于美国 MIMIC-IV 2.0数据库资料

熊雅欣.入院血糖影响重症监护室急性冠状动脉综合征患者的预后——基于美国 MIMIC-IV 2.0数据库资料[J].内科急危重症杂志,2024,30(6):512-518

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DOI：10.11768/nkjwzzzz.20240606

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基金项目:黑龙江省重点研发计划（GA21C011；JD22C005）

作者	单位	E-mail
熊雅欣	哈尔滨医科大学附属第一医院	mengzi98@163.com

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中文摘要:

摘要：目的：探讨入院血糖水平对重症监护室（ICU）急性冠状动脉综合征（ACS）患者预后的影响。方法：回顾性收集MIMIC-IV2.0数据库中首次入住ICU且符合研究要求的ACS患者。使用限制性立方样条（RCS）模型在连续水平上评估入院血糖水平与ACS患者预后之间的关系。采用四分位数法，依据患者入院血糖水平将其分为4组，应用多变量Cox回归模型分析入院血糖水平对ACS患者预后的影响。根据性别、年龄和伴或不伴糖尿病对入院血糖水平与90d死亡率之间的非线性关系进行分层分析。结果：入院血糖水平与ACS患者死亡率之间存在显著的非线性关系，当血糖水平≤107mg/dL（5.94mmol/L）时，患者死亡风险随血糖水平升高而降低，而当107mg/dL＜血糖水平≤244mg/dL（13.56mmol/L）或242mg/dL（13.43mmol/L）时，患者死亡风险随血糖水平的升高而升高，当血糖水平＞244mg/dL或242mg/dL时患者死亡风险稳定在较高水平。多变量Cox回归显示，血糖水平在第4个四分位数的患者死亡风险最高。结论：入院血糖水平与ACS患者死亡率之间存在显著的非线性关系，指出死亡风险最低时的血糖水平，为ACS患者的血糖调控提供了参考。

英文摘要:

Abstract Objective: To investigate the impact of admission blood glucose on the prognosis of patients with acute coronary syndrome (ACS) in the intensive care unit (ICU). Methods: We retrospectively collected data from patients with ACS who were first admitted to the ICU and met the study requirements in the MIMIC-IV 2.0 database. The restricted cubic spline (RCS) model was used to evaluate the association between admission blood glucose and prognosis of patients with ACS at the continuous level. The patients were divided into four groups based on their admission blood glucose using the quartile method, and the impact of admission blood glucose on ACS patient prognosis was analyzed using a multivariate Cox regression model. In addition, a stratified analysis was performed on the nonlinear relationship between admission blood glucose and 90-day mortality according to gender, age, and the presence or absence of diabetes. Results: There was a significant nonlinear relationship between admission blood glucose and mortality in ACS patients. When blood glucose≤ 107 mg/dL (5.94 mmol/L), the risk of death decreased with increasing blood glucose. When 107 mg/dL< blood glucose≤ 244 or 242 mg/dL (13.56 or 13.43 mmol/L), the risk of death increased with increasing blood glucose. When 107 mg/dL< blood glucose≤ 244 or 242 mg/dL, the risk of death remained stable at a high level. The multivariate Cox regression results showed that patients in the fourth quartile of blood glucose had the highest risk of death. Conclusion: Our study demonstrates a significant nonlinear relationship between admission blood glucose and mortality in ACS patients, indicating the optimal blood glucose level for minimizing the risk of death, providing a reference for blood glucose regulation in ACS patients.