【摘要】 目的：本研究旨在探讨老年ST段抬高型心肌梗死（ST-segment elevation myocardial infarction,STEMI）患者在接受直接PCI术后，预后营养指数（prognostic nutritional index,PNI）与1年主要不良心血管事件（major adverse cardiovascular events,MACE）发生风险的相关性。方法：本研究为单中心回顾性队列研究，纳入了于北京潞河医院行直接PCI的1 515例老年STEMI患者，随访12个月，主要结局为MACE。按PNI四分位数分为4组，使用Kaplan-Meier曲线分析不同PNI组别的预后，采用COX比例风险回归模型分析PNI与MACE的相关性。同时使用限制性立方样条（restricted cubic spline,RCS）曲线探索PNI与MACE风险之间的剂量反应关系。最后进行亚组分析。结果：较低PNI组患者的MACE发生率显著高于较高PNI组（组1 vs.组4:29.0%vs.12.8%,P<0.001）。Kaplan-Meier曲线分析显示，PNI水平越低，MACE(log-rank P<0.001)发生风险越高。COX回归分析表明，PNI与MACE呈显著负相关。在校正了混杂因素后，与组1(PNI≤47.9)相比，组4(PNI>54.9)患者的MACE风险下降55%(HR=0.45,95%CI:0.31～0.66，趋势P<0.001)。亚组分析结果显示，BMI<24.0kg/m2或患有2型糖尿病的患者中，PNI对MACE的保护作用更加显著（交互P均<0.001）。结论：PNI是老年STEMI患者直接PCI术后1年MACE的独立预测因子，低PNI可显著增加MACE发生风险。BMI<24.0 kg/m2以及2型糖尿病，PNI与MACE的相关性更强。更多还原

【Abstract】 Objective: This study aimed to investigate the association between the prognostic nutritional index(PNI) and the risk of 1-year major adverse cardiovascular events(MACE) in elderly patients with STsegment elevation myocardial infarction(STEMI) following primary PCI. Methods: This single-center retrospective cohort study included 1 515 elderly STEMI patients who underwent primary PCI at Beijing Luhe Hospital. Patients were followed up for 12 months, with MACE as the primary endpoint. Patients were divided into four groups based on PNI quartiles. Kaplan-Meier curves were used to analyze prognosis among different PNI groups. COX proportional hazards regression models were employed to analyze the association between PNI and MACE. Restricted cubic spline(RCS) curves were utilized to explore the dose-response relationship between PNI and MACE risk. Subgroup analyses were also performed. Results: The incidence of MACE was significantly higher in the lower PNI groups compared to the higher PNI groups(Group 1vs. Group 4: 29.0% vs. 12.8%, P<0.001). Kaplan-Meier curve analysis showed that lower PNI levels were associated with a higher risk of MACE(log-rank P<0.001). COX regression analysis revealed a significant negative correlation between PNI and MACE. After adjusting for confounding factors, compared to Group 1(PNI ≤ 47.9), Group 4(PNI>54.9) patients had a 55% lowerrisk of MACE(HR=0.45, 95%CI: 0.31-0.66, P for trend <0.001). Subgroup analyses indicated that the protective effect of PNI on MACE was more pronounced in patients with BMI<24.0kg/m2 or those with type 2 diabetes(interaction P<0.001). Conclusions:PNI is an independent predictor of 1-year MACE in elderly STEMI patients after primary PCI, with lower PNI significantly increasing the risk of MACE. The correlation between PNI and MACE is stronger in populations with BMI<24.0 kg/m2 and those with type 2 diabetes.更多还原