中性粒细胞与载脂蛋白 A1 比值与不同糖代谢状态急性失代偿性心力衰竭患者不良预后的相关性：一项回顾性队列研究。
The neutrophil-to-apolipoprotein A1 ratio is associated with adverse outcomes in patients with acute decompensated heart failure at different glucose metabolic states: a retrospective cohort study.
机构信息
Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China.
出版信息
Lipids Health Dis. 2024 Apr 22;23(1):118. doi: 10.1186/s12944-024-02104-1.
BACKGROUND
The present study was performed to assess the association between the neutrophil-to-apolipoprotein A1 ratio (NAR) and outcomes in patients with acute decompensated heart failure (ADHF) at different glucose metabolism states.
METHODS
We recruited 1233 patients with ADHF who were admitted to Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University from December 2014 to October 2019. The endpoints were defined as composites of cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke and exacerbation of chronic heart failure. The restricted cubic spline was used to determine the best cutoff of NAR, and patients were divided into low and high NAR groups. Kaplan-Meier plots and multivariable Cox proportional hazard models were used to investigate the association between NAR and the risk of adverse outcomes.
RESULTS
During the five-year follow-up period, the composite outcome occurred in 692 participants (56.1%). After adjusting for potential confounding factors, a higher NAR was associated with a higher incidence of composite outcomes in the total cohort (Model 1: HR = 1.42, 95% CI = 1.22-1.65, P<0.001; Model 2: HR = 1.29, 95% CI = 1.10-1.51, P = 0.002; Model 3: HR = 1.20, 95% CI = 1.01-1.42, P = 0.036). At different glucose metabolic states, a high NAR was associated with a high risk of composite outcomes in patients with diabetes mellitus (DM) (Model 1: HR = 1.54, 95% CI = 1.25-1.90, P<0.001; Model 2: HR = 1.40, 95% CI = 1.13-1.74, P = 0.002; Model 3: HR = 1.31, 95% CI = 1.04-1.66, P = 0.022), and the above association was not found in patients with prediabetes mellitus (Pre-DM) or normal glucose regulation (NGR) (both P>0.05).
CONCLUSIONS
The NAR has predictive value for adverse outcomes of ADHF with DM, which implies that the NAR could be a potential indicator for the management of ADHF.
背景
本研究旨在评估中性粒细胞与载脂蛋白 A1 比值（NAR）与不同葡萄糖代谢状态下急性失代偿性心力衰竭（ADHF）患者结局之间的相关性。
方法
我们招募了 2014 年 12 月至 2019 年 10 月期间入住南京大学医学院附属鼓楼医院的 1233 例 ADHF 患者。终点定义为心血管死亡、非致死性心肌梗死、非致死性缺血性卒中和慢性心力衰竭恶化的复合结局。使用限制性立方样条确定 NAR 的最佳截断值，并将患者分为低 NAR 和高 NAR 组。Kaplan-Meier 图和多变量 Cox 比例风险模型用于研究 NAR 与不良结局风险之间的关系。
结果
在 5 年随访期间，共有 692 名（56.1%）参与者发生复合结局。在调整潜在混杂因素后，高 NAR 与全队列中复合结局的发生率较高相关（模型 1：HR=1.42，95%CI=1.22-1.65，P<0.001；模型 2：HR=1.29，95%CI=1.10-1.51，P=0.002；模型 3：HR=1.20，95%CI=1.01-1.42，P=0.036）。在不同的葡萄糖代谢状态下，高 NAR 与糖尿病（DM）患者的复合结局风险升高相关（模型 1：HR=1.54，95%CI=1.25-1.90，P<0.001；模型 2：HR=1.40，95%CI=1.13-1.74，P=0.002；模型 3：HR=1.31，95%CI=1.04-1.66，P=0.022），而在糖尿病前期（Pre-DM）或正常血糖调节（NGR）患者中则未发现上述相关性（均 P>0.05）。
结论
NAR 对 DM 合并 ADHF 的不良结局具有预测价值，这意味着 NAR 可能成为 ADHF 管理的潜在指标。
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