SII联合TyG指数在低密度脂蛋白达标的急性 心肌梗死患者中的预测价值

Predictive Value of Combined SII and TyG Index in Acute Myocardial Infarction Patients with Achieved LDL-C Targets

摘要: 目的：探讨系统性免疫炎症指数(SII)联合甘油三酯–葡萄糖指数(TyG)在LDL-C < 1.4 mmol/L急性心肌梗死(AMI)患者中的预后预测价值。方法：回顾性纳入2012~2023年间诊断为AMI且LDL-C < 1.4 mmol/L的患者620例。主要终点为住院期间全因死亡。采用多因素Logistic回归分析评估SII和TyG与死亡的关系，限制性立方样条(RCS)分析探索非线性关系，采用ROC曲线分析SII联合TyG指数对低密度脂蛋白达标的急性心肌梗死患者院内死亡的预测价值。P < 0.05表示差异有统计学意义。结果：620例患者中，院内死亡43例(6.9%)。SII最高四分位数(Q4)与最低四分位数(Q1)相比，死亡风险显著升高(未调整OR = 6.24，95% CI：2.10~18.58；多因素调整后OR = 5.83，P < 0.001)。TyG各四分位数与死亡风险无显著关联(P > 0.05)。联合分组分析显示，高SII + 低TyG组死亡风险最高(OR = 5.89, 95% CI: 1.41~24.72, P = 0.015)。RCS分析显示SII与死亡风险呈非线性关系(P = 0.0287)，而TyG呈近似线性关系。结论：SII是LDL-C < 1.4 mmol/L的AMI患者院内死亡的独立预测因子且与死亡风险呈非线性关系。SII-TyG联合分组可有效识别高危人群，高SII + 低TyG组死亡风险最高。

Abstract: Objective: To explore the prognostic predictive value of systemic immune-inflammation index (SII) combined with triglyceride-glucose index (TyG) in patients with acute myocardial infarction (AMI) and low-density lipoprotein cholesterol (LDL-C) < 1.4 mmol/L. Methods: A total of 620 patients diagnosed with AMI and LDL-C < 1.4 mmol/L from 2012 to 2023 were retrospectively enrolled. The primary endpoint was in-hospital all-cause mortality. Multivariate Logistic regression analysis was used to evaluate the correlation between SII, TyG and mortality. Restricted cubic spline (RCS) analysis was applied to explore the nonlinear correlation. ROC curve was adopted to analyze the predictive efficacy of combined SII and TyG for in-hospital death in AMI patients achieving LDL-C target. A P value < 0.05 was considered statistically significant. Results: Among 620 patients, 43 cases (6.9%) died during hospitalization. Compared with the lowest quartile (Q1), the highest SII quartile (Q4) presented significantly higher mortality risk (unadjusted OR = 6.24, 95% CI: 2.10~18.58; adjusted OR = 5.83, P < 0.001). No significant correlation was found between TyG quartiles and mortality risk (P > 0.05). Combined stratified analysis showed that patients in high SII plus low TyG group carried the highest mortality risk (OR = 5.89, 95% CI: 1.41~24.72, P = 0.015). RCS analysis revealed a nonlinear relationship between SII and mortality risk (P = 0.0287), while TyG showed an approximately linear relationship. Conclusion: SII is an independent predictor, demonstrating a nonlinear relationship of in-hospital mortality in AMI patients with LDL-C < 1.4 mmol/L. Combined SII-TyG stratification can effectively identify high-risk populations, and patients with high SII and low TyG have the highest adverse prognosis risk.