Zhang Chong, Peng Wenjin, Wang Tianqi, Ning Meng, Chen Yi, Liu Yingwu
Neuroscience Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
The Third Central Clinical College of Tianjin Medical University, Tianjin, China.
J Diabetes. 2025 Aug;17(8):e70134. doi: 10.1111/1753-0407.70134.
In acute coronary syndrome (ACS) patients, the relationship between abnormal glucose metabolism markers, such as the triglyceride-glucose (TyG) index and stress hyperglycemia ratio (SHR), and inflammatory markers remains unclear. Furthermore, their interaction and impact on long-term prognosis have yet to be investigated in clinical cohorts.
In this study, K-means clustering was performed on the TyG index, SHR, and inflammatory markers, including high mobility group box-1 protein, platelet-derived growth factor, phenylacetylglutamine, lysophosphatidic acid, and citrullinated histone H3. A Cox proportional hazards model was used to assess the association between cluster phenotypes and 1-year major adverse cardiovascular events (MACE) risk in ACS patients.
Among 363 ACS patients, 62 developed MACE during the 1-year follow-up. SHR correlated positively with the TyG index and inflammatory markers. K-means clustering identified two phenotypes: normal glucose metabolism/low inflammation and abnormal glucose metabolism/high inflammation. Multivariable Cox analysis showed the latter was strongly linked to MACE (adjusted hazard ratio: 3.84, 95% confidence interval: 1.93-7.64), and early guideline-directed medical therapy reduced MACE risk in this high-risk group.
ACS patients with abnormal glucose metabolism and high inflammation have a higher long-term MACE risk than those with normal glucose metabolism and low inflammation. Early guideline-directed medical therapy, alongside anti-inflammatory therapy and hypoglycemic agents, may improve long-term outcomes in this high-risk group.
在急性冠状动脉综合征（ACS）患者中，甘油三酯-葡萄糖（TyG）指数和应激性高血糖比率（SHR）等异常糖代谢标志物与炎症标志物之间的关系尚不清楚。此外，它们在临床队列中的相互作用及其对长期预后的影响尚未得到研究。
在本研究中，对TyG指数、SHR以及包括高迁移率族蛋白B1、血小板衍生生长因子、苯乙酰谷氨酰胺、溶血磷脂酸和瓜氨酸化组蛋白H3在内的炎症标志物进行K均值聚类。采用Cox比例风险模型评估聚类表型与ACS患者1年主要不良心血管事件（MACE）风险之间的关联。
在363例ACS患者中，62例在1年随访期间发生了MACE。SHR与TyG指数和炎症标志物呈正相关。K均值聚类确定了两种表型：糖代谢正常/低炎症和糖代谢异常/高炎症。多变量Cox分析显示，后者与MACE密切相关（调整后风险比：3.84，95%置信区间：1.93 - 7.64），早期指南指导的药物治疗可降低该高危组的MACE风险。
糖代谢异常且炎症高的ACS患者比糖代谢正常且炎症低的患者具有更高的长期MACE风险。早期指南指导的药物治疗，联合抗炎治疗和降糖药物，可能改善该高危组的长期预后。
