TyG指数及改良TyG指数预测普通成年人NAFLD患病风险的价值  

The value of TyG index and modified TyG indices in predicting the risk of NAFLD in general adults

作　　者：曾冠男 卢世云[1] 施冰[1] ZENG Guan-nan;LU Shi-yun;SHI Bing(Department of Gastroenterology,Fujian Medical University Provincial School of Clinical Medicine,Fujian Provincial Hospital,Fuzhou 350028,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院南院消化内科,350028

出　　处：《中国现代药物应用》2022年第23期1-6,共6页Chinese Journal of Modern Drug Application

基　　金：福建省卫生健康科技计划项目医学创新课题(项目编号:2021CXA005);福建医科大学启航基金一般项目(项目编号:2020QH1188)。

摘　　要：目的 比较甘油三酯葡萄糖(TyG)指数及改良TyG指数[甘油三酯葡萄糖-体质量指数(TyG-BMI)、甘油三酯葡萄糖-腰围(TyG-WC)、甘油三酯葡萄糖-腰高比(TyG-WHtR)]预测普通成年人非酒精性脂肪性肝病(NAFLD)患病风险的价值。方法 收集分析2017~2018年美国国家健康和营养检查调查(NHANES)中年龄≥20岁的5569名参与者的数据,根据各种标准排除病例后最终纳入1236例参与者,再根据是否发生NAFLD将参与者分为NAFLD组[受控衰减参数(CAP)≥274 dB/m,467例]和非NAFLD组(769例)。根据公式分别计算TyG、TyG-BMI、TyG-WC、TyG-WHtR,进行受试者工作特征(ROC)曲线分析以评估每个参数预测NAFLD的能力。比较两组的临床特征和生化特征,评估TyG指数及改良TyG指数在预测NAFLD中的准确性和阈值,并分析其敏感性。结果 本研究共纳入1236例参与者,约35.2%的参与者患有NAFLD[95%CI=(32.1%,38.4%)]。两组性别和吸烟情况比较差异无统计学意义(P>0.05);NAFLD组的年龄、肥胖占比、空腹甘油三酯(TG)、空腹血糖(FPG)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、尿酸、体质量指数(BMI)、腰围(WC)、腰高比(WHtR)、TyG、TyG-BMI、TyG-WC、TyG-WHtR均高于非NAFLD组,差异具有统计学意义(P<0.05)。TyG指数预测NAFLD的准确性较差,改良TyG指数预测NAFLD的准确性明显提高。根据ROC曲线分析,TyG-WC的曲线下面积(AUC)(0.811)最大,95%CI=(0.786,0.835),敏感性为0.787,特异性为0.700,最佳阈值为822.376;其次是TyG-WHtR[AUC为0.801,95%CI=(0.776,0.826),敏感性为0.778,特异性为0.704,最佳阈值为4.974]和TyG-BMI[AUC为0.791,95%CI=(0.776,0.816),敏感性为0.809,特异性为0.653,最佳阈值为232.102]。在亚组分析中,改良TyG指数预测NAFLD的准确性也均优于TyG指数。在敏感性分析中,不管CAP采用何截止值,改良TyG指数预测NAFLD的准确性均优于TyG指数。结论 改良TyG指数在识别普通成年人NAFLD患病方面优于TyG指数,特别是TyG-WC显示�Objective To compare the value of triglyceride-glucose(TyG) index and modified TyG indices [TyG-body mass index(TyG-BMI),TyG-waist circumference(TyG-WC),TyG-waist to height ratio(TyG-WHtR)] in predicting the risk of non-alcoholic fatty liver disease(NAFLD) in general adults.Methods Data from 5569 participants aged ≥20 years in the National Health and Nutrition Examination Survey(NHANES)from 2017 to 2018 were collected and analyzed,and 1236 participants were finally included after excluding cases according to various criteria,and then the participants were divided into NAFLD group [controlled attenuation parameter(CAP) ≥274 dB/m,467 cases] and non-NAFLD group(769 cases) according to whether NAFLD occurred or not.Receiver operating characteristic(ROC) curve analysis was performed to assess the ability of each parameter to predict NAFLD by calculating TyG,TyG-BMI,TyG-WC,and TyG-WHtR according to the formula.The clinical and biochemical characteristics of the two groups were compared to assess the accuracy and threshold of TyG index and modified TyG indices in predicting NAFLD and to analyze their sensitivity.Results A total of 1236 participants were included in this study,and approximately 35.2% had NAFLD [95%CI=(32.1%,38.4%)].There was no statistically significant difference between the two groups in terms of gender and smoking status(P>0.05).The age,obesity percentage,fasting triglyceride(TG),fasting plasma glucose(FPG),glutamic aminotransferase(ALT),aspartate transaminase(AST),uric acid,body mass index(BMI),waist circumference(WC),waist to height ratio(WHtR),TyG,TyG-BMI,TyG-WC,TyG-WHtR in the NAFLD group were higher than those in the non-NAFLD group,and the differences were all statistically significant(P<0.05).The accuracy of TyG index in predicting NAFLD was poor,and the accuracy of modified TyG indices in predicting NAFLD was significantly improved.According to ROC curve analysis,TyG-WC had the largest area under the curve(AUC)(0.811) [95%CI=(0.786,0.835),sensitivity of 0.787,specificity of 0.700 and optim

关 键 词：甘油三酯葡萄糖指数 改良甘油三酯葡萄糖指数 非酒精性脂肪性肝病 

分 类 号：R575[医药卫生—消化系统]