Jiang Ruihao, Li Yiyang, Cheng Lin, Ni Weicheng, Ni Qingwei, Zhu Jianhan, Lin Ken, Ke Jiayu, Gao Zhan, Zhou Hao
Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
BMC Cardiovasc Disord. 2025 Jul 4;25(1):482. doi: 10.1186/s12872-025-04907-1.
The Stress Hyperglycemia Ratio (SHR), which serves as an indicator of blood glucose variability in response to acute illness or injury, has been established as a predictor of long-term prognosis for various diseases, particularly those affecting cardiovascular health. However, the relationship between SHR and patients presenting with acute coronary syndrome (ACS) in conjunction with chronic kidney disease (CKD) remains to be fully elucidated.
From January 2013 to December 2019, this study enrolled a total of 465 patients with ACS complicated by CKD at the First Affiliated Hospital of Wenzhou Medical University. Fasting blood glucose (FBG), glycated hemoglobin, and other relevant parameters were recorded for these patients, and they were followed up for major adverse cardiovascular events (MACE).
A total of 465 patients were ultimately included, of whom 97 experienced MACE during the follow-up period. Multivariate Cox regression analysis revealed that SHR is an independent risk factor for patients with ACS complicated by CKD. The group with elevated SHR exhibited the highest incidence of MACE, and a nonlinear "J-shaped" relationship was observed between SHR and the risk of MACE, with an inflection point at 0.84. However, no significant heterogeneity was noted in the subgroup analysis. The inclusion of SHR enhances the predictive capability of the GRACE score.
SHR serves as a reliable indicator of long-term outcomes in patients with ACS and CKD. Additionally, SHR enhances the prognostic accuracy of the GRACE score for ACS-CKD patients.
应激性高血糖比值（SHR）作为反映急性疾病或损伤时血糖变异性的指标，已被确立为多种疾病长期预后的预测指标，尤其是那些影响心血管健康的疾病。然而，SHR与合并慢性肾脏病（CKD）的急性冠状动脉综合征（ACS）患者之间的关系仍有待充分阐明。
2013年1月至2019年12月，本研究纳入了温州医科大学附属第一医院共465例合并CKD的ACS患者。记录这些患者的空腹血糖（FBG）、糖化血红蛋白及其他相关参数，并对其进行主要不良心血管事件（MACE）随访。
最终共纳入465例患者，其中97例在随访期间发生MACE。多因素Cox回归分析显示，SHR是合并CKD的ACS患者的独立危险因素。SHR升高组的MACE发生率最高，且观察到SHR与MACE风险之间呈非线性“J形”关系，拐点为0.84。然而，亚组分析未发现显著异质性。纳入SHR可提高GRACE评分的预测能力。
SHR是合并ACS和CKD患者长期预后的可靠指标。此外，SHR提高了GRACE评分对ACS-CKD患者的预后准确性。
