甘油三酯葡萄糖指数对急性心肌梗死患者急性肾损伤风险的预测价值

Predictive Value of Triglyceride Glucose Index on the Risk of Acute Kidney Injury in Patients with Acute Myocardial Infarction

摘要: 背景：甘油三酯葡萄糖指数(TyG指数)作为胰岛素抵抗的可靠替代指标，近年来受到广泛关注，但其在预测急性心肌梗死(AMI)患者急性肾损伤(AKI)发生的预测价值不得而知。方法：我们成功纳入MIMIC-IV 3.0数据库中953名患者进入研究队列，通过Lasso回归筛选变量，单、多因素logistic回归确定TyG指数以及其他变量与AMI后AKI的关联。结果：总共有517名患者AMI后发生AKI，其TyG指数升高(8.96 vs 9.15，p < 0.05)；并且TyG指数升高的患者更易发生AKI (61.5% vs 46.8%)。TyG指数是AMI后AKI的独立预测因子(OR = 1.36, 95% CI = 1.06~1.75)，但是预测效能是中等的(曲线下面积，AUC = 0.594)，肌酐的预测效能最大(AUC = 0.828)，将logistic回归筛选出的变量联合预测效能更佳(AUC = 0.849)。结论：TyG指数对AMI后AKI风险具有独立的预测价值，但是预测效能是中等的。

Abstract: Background: The triglyceride glucose index (TyG index) has received much attention in recent years as a reliable surrogate for insulin resistance, but its predictive value in predicting the occurrence of acute kidney injury (AKI) in patients with acute myocardial infarction (AMI) is unknown. Methods: We successfully included 953 patients from the MIMIC-IV 3.0 database into the study cohort, and screened variables by Lasso regression, and single- and multi-variate logistic regression to determine the associations of the TyG index, as well as other variables, with AKI after AMI. Results: A total of 517 patients who developed AKI after AMI had an elevated TyG index (8.96 vs. 9.15, p < 0.05); and patients with an elevated TyG index were more likely to develop AKI (61.5% vs. 46.8%). The TyG index was an independent predictor of post-AMI AKI (OR = 1.36, 95% CI 1.06~1.75), but the predictive efficacy was moderate (area under the curve, AUC = 0.594), with creatinine having the greatest predictive efficacy (AUC = 0.828), and the combined predictive efficacy of variables screened by logistic regression being better (AUC = 0.849). Conclusion: The TyG index has an independent predictive value for the risk of AKI after AMI, but the predictive efficacy is moderate.