上海交通大学学报(医学版) ›› 2022, Vol. 42 ›› Issue (3): 267-274.doi: 10.3969/j.issn.1674-8115.2022.03.002

• 心脑血管慢病协防共管专题 • 上一篇    下一篇

无传统危险因素人群中TyG指数与心脑血管疾病的关系

张彤1(), 田雪2, 左颖婷2, 郑曼琪2, 张怡君1,3, 吴寿岭4, 陈朔华4, 马高亭5, 佟旭5, 王安心1,3, 莫大鹏5()   

  1. 1.首都医科大学附属北京天坛医院神经病学中心,北京 100070
    2.首都医科大学公共卫生学院流行病与卫生统计学系,北京 100069
    3.首都医科大学附属北京天坛医院,国家神经系统疾病临床医学研究中心,北京 100070
    4.河北省唐山市开滦总医院心内科,唐山 063000
    5.首都医科大学附属北京天坛医院神经介入中心,北京 100070
  • 收稿日期:2021-12-30 出版日期:2022-03-28 发布日期:2022-05-09
  • 通讯作者: 莫大鹏 E-mail:skyscorpion0168@hotmail.com;modapeng1971@163.com
  • 作者简介:张彤(1975—),女,副主任医师,博士;电子信箱:skyscorpion0168@hotmail.com
  • 基金资助:
    国家重点研发计划(2018YFC1312800)

Association of triglyceride-glucose index with cardiovascular disease in people without traditional risk factors

Tong ZHANG1(), Xue TIAN2, Yingting ZUO2, Manqi ZHENG2, Yijun ZHANG1,3, Shouling WU4, Shuohua CHEN4, Gaoting MA5, Xu TONG5, Anxin WANG1,3, Dapeng MO5()   

  1. 1.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
    2.Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
    3.China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
    4.Department of Cardiology, Kailuan General Hospital, Tangshan City, Hebei Province, Tangshan 063000, China
    5.Department of Neurological Intervention, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
  • Received:2021-12-30 Online:2022-03-28 Published:2022-05-09
  • Contact: Dapeng MO E-mail:skyscorpion0168@hotmail.com;modapeng1971@163.com
  • Supported by:
    National Key R&D Program of China(2018YFC1312800)

摘要:

目的·探索在无传统心脑血管疾病危险因素的人群中,三酰甘油-葡萄糖指数(triglyceride-glucose index,TyG)与心脑血管疾病的关联。方法·研究包括来自中国唐山市开滦社区队列研究的32 532名于2006—2007年基线调查没有心脑血管疾病病史,且没有动脉粥样硬化心脑血管疾病(atherosclerotic cardiovascular disease,ASCVD)危险因素(包括血脂异常、高血压、吸烟、糖尿病)的观察者[男性64.01%;平均年龄(48.26±12.89)岁]。TyG指数计算为:ln[三酰甘油(mg/dL)×葡萄糖(mg/dL)/2]。根据TyG指数水平将入选人群进行四分位分组,即Q1、Q2、Q3以及Q4组。研究随访至2019年12月31日,研究的主要结局是随访期间新发心脑血管疾病(包括心肌梗死和脑卒中)。定量资料组间比较采用方差分析或Kruskal-Wallis检验,定性资料组间比较采用χ2检验。使用多因素Cox比例风险模型来评估TyG指数水平与心脑血管疾病风险的关联性。采用5节点(第5、25、50、75以及95个百分位)限制性立方样条图进一步研究TyG指数水平和心脑血管疾病之间的剂量反应关系,双侧检验P < 0.05为差异有统计学意义。结果·在中位随访12.97(12.67,3.17)年间,研究观察到1 324例新发心脑血管疾病,其中1 084例脑卒中和255例心肌梗死。校正了其他混杂因素后,多因素Cox回归分析结果显示,与TyG指数Q1组相比,Q2组、Q3组以及Q4组的人群新发心脑血管疾病的风险比为1.16(95%CI 0.97~1.38)、1.29(95%CI 1.08~1.53)和1.60(95%CI 1.35~1.90);出现脑卒中的风险比为1.12(95%CI 0.93~1.36)、1.21(95%CI 1.00~1.46)和1.44(95%CI 1.20~1.73);出现心肌梗死的风险比为1.32(95%CI 0.84~2.06)、1.64(95%CI 1.07~2.51)和2.41(95%CI 1.60~3.65)。敏感分析性得到相似的结果。在不同性别人群中,亚组分析显示不同性别人群中TyG指数和心脑血管疾病的关系一致,性别与TyG指数不存在显著的交互作用。并且多变量调整限制性立方样条回归模型显示,TyG指数与心脑血管疾病、脑卒中及心肌梗死发生风险之间呈J型关联。结论·在没有传统ASCVD危险因素的个体中,随着TyG指数水平的增加,心脑血管疾病的发生风险随之增加。

关键词: 三酰甘油-葡萄糖指数, 心血管疾病, 无传统心脑血管危险因素, 关联分析, 队列研究

Abstract:

Objective·To examine the association of triglyceride-glucose index with cardiovascular disease (CVD) in participants without atherosclerotic CVD (ASCVD) risk factors.

Methods·This study included 32 532 participants [64.01% male, mean age (48.26±12.89) years] who had no history of CVD and no ASCVD risk factors (including dyslipidemia, hypertension, smoking and diabetes) at baseline from Kailuan Study during 2006?2007. Participants were divided into 4 groups according to the quintiles of TyG index at baseline (Q1, Q2, Q3 and Q4). TyG index was calculated as ln[triglyceride (mg/dL)×fasting blood glucose (mg/dL)/2]. The outcome was the first occurrence of CVD from baseline to the end of follow-up (December 31, 2019). Baseline characteristics were compared with one-way ANOVA or Kruskal-Wallis test for continuous variables, and chi-square for categorized variables. Multivariable-adjusted Cox proportional hazards models were performed to evaluate the associations. Restricted cubic spline with 5 knots at the 5th, 25th, 50th, 75th and 95th percentile was used to explore the dose-response association between TyG index and incident CVD. A two-sided P<0.05 was considered statistically significant.

Results·During a median follow-up of 12.97 (12.67, 13.17) years, we observed 1 324 incident CVD events (including 1 084 cases of stroke and 255 cases of myocardial infarction). Compared with participants in the Q1 group, the multivariable adjusted hazard ratios in the Q2, Q3 and Q4 group were 1.16 (95%CI 0.97?1.38), 1.29 (95%CI 1.08?1.53) and 1.60 (95%CI 1.35?1.90) for CVD, 1.12 (95%CI 0.93?1.36), 1.21 (95%CI 1.00?1.46) and 1.44 (95%CI 1.20?1.73) for stroke, and 1.32 (95%CI 0.84?2.06), 1.64 (95%CI 1.07?2.51) and 2.41 (95%CI 1.60?3.65) for myocardial infarction, respectively. Sensitivity analyses yielded similar results. Subgroup analysis showed that the association between TyG index and CVD was consistent across different gender populations, and there was no significant interaction between gender and TyG index in relation to the risk of CVD. Multivariable-adjusted spline regression model showed a J-shaped association between TyG index and the risk of CVD, stroke and myocardial infarction. Similar results were observed when stroke and myocardial infarction were the interest of outcomes.

Conclusion·Among the individuals without traditional ASCVD risk factors, there is an increased risk of incident CVD with increasing TyG index level.

Key words: triglyceride-glucose index, cardiovascular disease (CVD), without atherosclerotic cardiovascular risk factor, association analysis, cohort study

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