摘要目的:探讨控制营养状况（controlling nutritional status，CONUT）积分对接受经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）的冠心病患者临床结局的影响。研究对象:本研究的数据来源于一项回顾性队列研究的10年随访结果分析。连续纳入2008年1月至2016年12月就诊于新疆医科大学第一附属医院的6 050例接受PCI治疗的冠心病患者，排除4例临床或随访资料不全患者。其中，男性患者为4 497例，年龄为（59.5±10.8）岁。干预措施:本研究为回顾性研究，平均随访32个月。对纳入分析的患者计算CONUT积分，根据积分高低分为5组，并分析各组临床结局的差异。观测指标及测量方法:纳入6 046例行冠状动脉支架置入的患者，按照CONUT积分由低到高分为5组：1组，CONUT积分=1， n=1 619；2组，CONUT积分＝2， n=1 791; 3组，CONUT积分＝3， n=1 847; 4组，CONUT积分＝4， n=633; 5组，CONUT积分≥5， n=156。主要终点事件为全因死亡和心源性死亡，次要终点事件为主要不良心血管事件发生率（major adverse cardiovascular events, MACEs）和主要不良心脑血管事件（major adverse cardiovascular and cerebrovascular events, MACCEs）发生率。采用单因素方差分析明确CONUT积分的影响因素，采用χ 2检验比较不同组别的患者临床结局的特征；采用Kaplan-Meier法绘制生存曲线比较随访时不同CONUT积分分层与不同临床结局的关系，经多因素Cox比例风险回归模型分析术前CONUT积分对冠心病PCI术后远期预后的预测价值。 结果:从1组到5组，全因死亡率分别为5.3%、5.6%、3.8%、5.8%和10.3%（ P=0.003），心源性死亡率分别为4.5%、4.2%、3.2%、4.4%和7.0%（ P=0.009）。可以看出无论全因死亡还是心源性死亡均与CONUT积分呈U形曲线关系。当CONUT积分为3分时，全因死亡和心源性死亡的发生率最低。另外，MACEs和MACCEs的发生率和CONUT积分的关系也呈U形曲线关系。经多因素Cox回归分析在调整了其他的危险因素之后这种趋势仍然存在。 结论:CONUT积分与冠心病患者PCI术后不良临床结局呈U形曲线关系，当CONUT积分为3分时，不良事件的发生率最低。

abstractsBackground and Objective:The Controlling Nutritional Status (CONUT) score is an index calculated using the serum albumin concentration, total lymphocyte count, and total cholesterol concentration. However, the relationship between the CONUT score and coronary artery disease (CAD) prognosis is unclear. Here we aimed to investigate the effect of CONUT score on clinical outcomes for CAD patients who underwent percutaneous coronary intervention(PCI).Subjects:The data for this study were derived from a 10-year follow-up analysis of a retrospective cohort study. A total of 6 050 CAD patients after PCI who attended the First Affiliated Hospital of Xinjiang Medical University between January 2008 and December 2016 were included. Four patients were excluded for clinical data unavailability. Of the study population, 4 497 patients were male, and the mean age was (59.5±10.8) years.Interventions:This retrospective study had an average follow-up of 32 months. The CONUT scores were calculated for the patients included in the analysis, patients were divided into five groups accordingly, and intergroup differences in clinical outcomes were analyzed.Main Outcomes and Measurements:A total of 6, 046 CAD patients who underwent PCI were divided into five groups according to CONUT score from the lowest to the highest (Group 1 [CONUT score=1, n=1 619], Group 2 [CONUT score=2, n=1 791], Group 3 [CONUT score= 3, n=1 847], Group 4 [CONUT score=4, n=633], and Group 5 [CONUT score ≥5, n=156]). The primary endpoints were all-cause mortality (ACM) and cardiac mortality (CM), while the secondary endpoints were major adverse cardiovascular events (MACEs) and major adverse cardiovascular and cerebrovascular events (MACCEs). One-way ANOVA was used to clarify the factors influencing CONUT score. The Chi-square test was used to compare the characteristics of adverse outcomes of the different groups. Kaplan-Meier analysis was used to compare the cumulative incidences of long-term adverse outcomes. Multivariate Cox regression analysis was performed to evaluate the effect of CONUT score on clinical outcomes. Results:For Groups 1 to 5, ACM rates were 5.3%, 5.6%, 3.8%, 5.8%, and 10.3%, respectively ( P=0.003), while CM rates were 4.5%, 4.2%, 3.2%, 4.4%, and 7.0%, respectively ( P=0.009). Both ACM and CM showed a U-shaped curve relationship with the CONUT score. The incidence of all-cause death and cardiac death was lowest when the CONUT score was 3. The relationship of the incidence of MACEs and MACCEs also showed a U-shaped curve relationship. The multivariate Cox proportional hazards model showed that the association remained significant after the adjustment for confounders. Conclusions:The CONUT score was associated with adverse outcomes in CAD patients who underwent PCI in a U-shaped curve. The incidence of adverse outcomes was lowest when the CONUT score was 3.