探讨三酰甘油葡萄糖指数对内脏型肥胖人群甲状腺结节患病风险的中介效应研究  

The mediation effect of triglyceride glucose index on the risk of thyroid nodule in visceral obese population

作　　者：秦迁[1] 杨阳[1] 闫航[1] 闫肃 王守俊[2] 丁素英[1] Qin Qian;Yang Yang;Yan Hang;Yan Su;Wang Shoujun;Ding Suying(Health Management Center,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Endocrinology and Metabolic Diseases,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院健康管理中心,郑州450052 [2]郑州大学第一附属医院内分泌与代谢病科,郑州450052

出　　处：《中华内分泌代谢杂志》2023年第9期733-738,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：河南省科技攻关计划项目(222102310226);河南省医学科技攻关计划联合共建项目(LHGJ20210354)。

摘　　要：目的探讨三酰甘油葡萄糖指数(TyG)对内脏型肥胖人群甲状腺结节患病风险的中介效应。方法选取2017年1月至2021年12月于郑州大学第一附属医院健康管理中心进行健康体检者9 324名, 收集其基本信息、生化指标、甲状腺彩超等结果。以内脏脂肪面积(VFA)为100 cm2和体重指数(BMI)为24 kg/m2作为临界值, 分为VFA(-)BMI(-)、VFA(-)BMI(+)、VFA(+)BMI(-)、VFA(+)BMI(+)组。采用卡方检验比较4组患病率差异, 多因素logistic回归分析影响因素;将TyG和VFA按照四分位数分组, 采用多因素logistic回归分析TyG、VFA对甲状腺结节患病风险的影响;回归系数依次检验法分析TyG是否介导VFA与甲状腺结节患病率之间的关联。结果多因素logistic回归分析显示, 与VFA(-)BMI(-)组相比, VFA(+)BMI(-)组甲状腺结节患病风险最高(OR=1.283, 95%CI 1.064~1.546,P=0.009), VFA(+)BMI(+)次之(OR=1.245, 95%CI 1.028~1.508,P=0.025);以TyG和VFA各自Q1为对照组, Q4组甲状腺结节患病风险增加1.584倍(95%CI 1.208~2.077,P=0.001)和1.573倍(95%CI 1.249~1.982,P<0.001)。中介效应分析显示, VFA对甲状腺结节患病率具有直接影响(β=0.162, 95%CI 0.140~0.186,P<0.001), TyG部分介导VFA对甲状腺结节患病率的影响(β=0.103, 95%CI 0.087~0.121,P<0.001), 中介效应占总效应的38.87%。结论无论BMI是否超标, VFA是甲状腺结节患病的独立危险因素, 内脏型肥胖而BMI正常者甲状腺结节患病率最高, 而TyG部分介导内脏型肥胖患者甲状腺结节患病率的风险。内脏型肥胖的评估对于甲状腺结节的早期筛查和防治可能具有重要意义。Objective To investigate the mediation effect of triglyceride glucose index(TyG)on the relation between thyroid nodules and visceral fat area.Methods A total of 9324 individuals at the Health Management Center of the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2021 were selected,and the basic information,biochemical indicators,color ultrasound of thyroid were also collected.According to the cut-off value of visceral fat area(VFA)of 100 cm2 and body mass index(BMI)of 24 kg/m2,they were divided into four groups:VFA(-)BMI(-),VFA(-)BMI(+),VFA(+)BMI(-),and VFA(+)BMI(+).Chi-square test was used to compare the incidence rate among the four groups,and multivariate logistic regression analysis to indentify influencing factors.TyG and VFA were quartiled,and multivariate logistic regression analysis was used to explore the effects of TyG and VFA on thyroid nodules.The regression coefficient test was used to analyze whether TyG mediated the association between VFA and thyroid nodules.Results Multivariate logistic regression analysis revealed that compared with VFA(-)BMI(-)group,the VFA(+)BMI(-)group had the highest risk of thyroid nodules(OR=1.283,95%CI 1.064-1.546,P=0.009),followed by VFA(+)BMI(+)group(OR=1.245,95%CI 1.028-1.508,P=0.025).When using TyG and VFA Q1 group as reference,the Q4 group showed an increased risk of thyroid nodule by 1.584 times(95%CI 1.208-2.077,P=0.001)and 1.573 times(95%CI 1.249-1.982,P<0.001),respectively.Mediation analysis indicated that VFA had a direct impact on the incidence rate of thyroid nodules(β=0.162,95%CI 0.140-0.186,P<0.001).TyG partially mediated the effect of VFA on the incidence rate of thyroid nodules(β=0.103,95%CI 0.087-0.121,P<0.001),accounting for 38.87%of the total effect.Conclusions VFA is an independent risk factor for thyroid nodules regardless of BMI.Among individuals with visceral obesity but normal BMI,the incidence rate of thyroid nodules was the highest.In addition,TyG partially mediates the risk of thyroid nodules in patients with

关 键 词：内脏型肥胖 三酰甘油葡萄糖指数 胰岛素抵抗 甲状腺结节 中介效应 

分 类 号：R589.2[医药卫生—内分泌] R581[医药卫生—内科学]