预测接受经皮冠状动脉介入治疗的糖尿病患者的预后：那不勒斯预后评分在真实世界临床研究中的价值。
Predicting the prognosis of diabetic patients undergoing percutaneous coronary intervention: the value of the Naples prognostic score in a real-world clinical study.
作者信息
Zhou Mengzhu, Zhang Xue, Guo Xiaohua, Duan Junying, Zhang Haifeng, Liu Xing, Liu Tong, Chen Kangyin, Liu Changle
机构信息
Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
出版信息
BMC Cardiovasc Disord. 2025 Jun 2;25(1):425. doi: 10.1186/s12872-025-04849-8.
BACKGROUND
The Naples prognostic score (NPS) evaluates the body's systemic inflammatory and metabolic status. However, its relevance for patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI) is uncertain.
METHODS
This study involved 1,485 diabetes patients following PCI from 2019 to 2023. Participants were divided into two groups based on their NPS. The primary endpoint was major adverse cardiovascular events (MACE). Secondary endpoints included components of MACE [all-cause mortality, recurrent myocardial infarction (MI), target vessel revascularization (TVR)], as well as cardiac death and stroke.
RESULTS
The novel NPS model demonstrated greater predictive capacity for cardiac death in comparison to the conventional diabetes risk score (AUC: 0.711 vs. 0.560, ∆AUC: +0.151, P = 0.044).The NPS model exhibited comparable predictive power to the GRACE score with respect to MACE events, with the difference proving to be statistically non-significant (∆AUC: -0.002, P = 0.940). Kaplan-Meier analysis revealed higher incidences of MACE (8.0% vs. 3.6%, P < 0.001), all-cause mortality (4.1% vs. 1.0%, P < 0.001), cardiac death (2.9% vs. 0.4%, P < 0.001), and stroke (4.1% vs. 2.2%, P = 0.035) in the high-risk NPS group compared to the low-risk group. Multivariate analysis identified high-risk NPS as an independent predictor of MACE (HR: 2.34; 95% CI: 1.50-3.67; P < 0.001), all-cause mortality (HR: 4.20; 95% CI: 1.95-9.04; P < 0.001), and cardiac death (HR: 6.68; 95% CI: 2.25-19.85; P < 0.001). These associations remained significant after adjusting for multiple risk factors.
CONCLUSION
High-risk NPS correlates with a higher incidence of cardiovascular events in diabetic patients following PCI. Additionally, NPS is a more reliable predictor of survival outcomes than other inflammatory and metabolic indicators.
CLINICAL TRIAL NUMBER
Not applicable.
背景
那不勒斯预后评分（NPS）评估机体的全身炎症和代谢状态。然而，其对于接受经皮冠状动脉介入治疗（PCI）的糖尿病（DM）患者的相关性尚不确定。
方法
本研究纳入了2019年至2023年接受PCI治疗的1485例糖尿病患者。参与者根据其NPS分为两组。主要终点是主要不良心血管事件（MACE）。次要终点包括MACE的组成部分[全因死亡率、复发性心肌梗死（MI）、靶血管血运重建（TVR）]，以及心源性死亡和中风。
结果
与传统糖尿病风险评分相比，新型NPS模型对心源性死亡具有更强的预测能力（AUC：0.711对0.560，∆AUC：+0.151，P = 0.044）。在MACE事件方面，NPS模型与GRACE评分具有相当的预测能力，差异无统计学意义（∆AUC：-0.002，P = 0.940）。Kaplan-Meier分析显示，高风险NPS组的MACE（8.0%对3.6%，P < 0.001）、全因死亡率（4.1%对1.0%，P < 0.001）、心源性死亡（2.9%对0.4%，P < 0.001）和中风（4.1%对2.2%，P = 0.035）发生率均高于低风险组。多因素分析确定高风险NPS是MACE（HR：2.34；95%CI：1.50 - 3.67；P < 0.001）、全因死亡率（HR：4.20；95%CI：1.95 - 9.04；P < 0.001）和心源性死亡（HR：6.68；95%CI：2.25 - 19.85；P < 0.001）的独立预测因素。在调整多个风险因素后，这些关联仍然显著。
结论
高风险NPS与PCI术后糖尿病患者心血管事件的较高发生率相关。此外，与其他炎症和代谢指标相比，NPS是生存结局更可靠的预测指标。
临床试验编号
不适用。
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