预后营养指数水平和糖尿病状态与冠状动脉疾病预后的关联：一项队列研究
Association of prognostic nutritional index level and diabetes status with the prognosis of coronary artery disease: a cohort study.
作者信息
Li Tianyu, Yuan Deshan, Wang Peizhi, Zeng Guyu, Jia Sida, Zhang Ce, Zhu Pei, Song Ying, Tang Xiaofang, Gao Runlin, Xu Bo, Yuan Jinqing
机构信息
National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, North Lishi Road, Xicheng District, Beijing, 100037, China.
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, North Lishi Road, Xicheng District, Beijing, 100037, China.
出版信息
Diabetol Metab Syndr. 2023 Mar 25;15(1):58. doi: 10.1186/s13098-023-01019-8.
BACKGROUND
Malnutrition and inflammation are associated with adverse clinical outcomes in patients with diabetes or coronary artery disease (CAD). Prognostic nutritional index (PNI) is a comprehensive and simple indicator reflecting nutritional condition and immunological status. Whether there is a crosstalk between nutritional-immunological status and diabetes status for the impact on the prognosis of coronary artery disease (CAD) is unclear.
METHODS
A total of 9429 consecutive CAD patients undergoing percutaneous coronary intervention were grouped by diabetes status [diabetes (DM) and non-diabetes (non-DM)] and preprocedural PNI level [high PNI (H-PNI) and low PNI (L-PNI)] categorized by the statistically optimal cut-off value of 48.49. The primary endpoint was all-cause death.
RESULTS
During a median follow-up of 5.1 years (interquartile range: 5.0-5.1 years), 366 patients died. Compared with the non-DM/H-PNI group, the DM/L-PNI group yielded the highest risk of all-cause death (adjusted hazard ratio: 2.65, 95% confidence interval: 1.97-3.56, p < 0.001), followed by the non-DM/L-PNI group (adjusted hazard ratio: 1.44, 95% confidence interval: 1.05-1.98, p = 0.026), while DM/H-PNI was not associated with the risk of all-cause death. The negative effect of L-PNI on all-cause death was significantly stronger in diabetic patients than in nondiabetic patients (p for interaction = 0.037). Preprocedural PNI category significantly improved the Global Registry of Acute Coronary Events (GRACE) risk score for predicting all-cause death in patients with acute coronary syndrome, especially in those with diabetes.
CONCLUSIONS
CAD patients with diabetes and L-PNI experienced the worst prognosis. The presence of diabetes amplifies the negative effect of L-PNI on all-cause death. Poor nutritional-immunological status outweighs diabetes in increasing the risk of all-cause death in CAD patients. Preprocedural PNI can serve as an assessment tool for nutritional and inflammatory risk and an independent prognostic factor in CAD patients, especially in those with diabetes.
背景
营养不良和炎症与糖尿病或冠状动脉疾病（CAD）患者的不良临床结局相关。预后营养指数（PNI）是反映营养状况和免疫状态的一个综合且简单的指标。营养免疫状态与糖尿病状态之间是否存在相互作用从而影响冠状动脉疾病（CAD）的预后尚不清楚。
方法
共有9429例接受经皮冠状动脉介入治疗的连续性CAD患者，根据糖尿病状态[糖尿病（DM）和非糖尿病（非DM）]以及术前PNI水平[高PNI（H-PNI）和低PNI（L-PNI），根据统计学最佳临界值48.49进行分类]进行分组。主要终点是全因死亡。
结果
在中位随访5.1年（四分位间距：5.0 - 5.1年）期间，366例患者死亡。与非DM/H-PNI组相比，DM/L-PNI组全因死亡风险最高（调整后风险比：2.65，95%置信区间：1.97 - 3.56，p < 0.001），其次是非DM/L-PNI组（调整后风险比：1.44，95%置信区间：1.05 - 1.98，p = 0.026），而DM/H-PNI与全因死亡风险无关。L-PNI对全因死亡的负面影响在糖尿病患者中比在非糖尿病患者中显著更强（交互作用p = 0.037）。术前PNI分类显著改善了急性冠状动脉综合征患者预测全因死亡的全球急性冠状动脉事件注册（GRACE）风险评分，尤其是糖尿病患者。
结论
糖尿病合并低PNI的CAD患者预后最差。糖尿病的存在放大了低PNI对全因死亡的负面影响。在增加CAD患者全因死亡风险方面，不良的营养免疫状态比糖尿病的影响更大。术前PNI可作为CAD患者营养和炎症风险的评估工具以及独立的预后因素，尤其是糖尿病患者。
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