甘油三酯葡萄糖乘积指数及结合肥胖指标与心血管疾病关联的前瞻性队列研究  

Prospective cohort study of the association of cardiovascular disease with triglyceride glucose index and triglyceride glucose-related indicators

作　　者：王淑琳 张向辉[1] 木拉提[1] 郭恒[1] 何佳[1] 热米娜 王馨平 马儒林[1] 郭淑霞[1,2] Wang Shulin;Zhang Xianghui;Mulatibieke;Guo Heng;He Jia;Remina;Wang Xinping;Ma Rulin;Guo Shuxia(Department of Public Health,Shihezi University School of Medicine,Shihezi 832000,China;National Health Commission Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases,Shihezi 832000,China)

机构地区：[1]石河子大学医学院预防医学系,石河子832000 [2]国家卫生健康委中亚高发病防治重点实验室,石河子832000

出　　处：《中华流行病学杂志》2023年第12期1943-1949,共7页Chinese Journal of Epidemiology

基　　金：新疆生产建设兵团重点领域科技攻关项目(2021AB030)。

摘　　要：目的:探讨新疆生产建设兵团维吾尔族人群甘油三酯葡萄糖乘积指数(TyG)及结合肥胖指标与心血管疾病(CVD)的关联。方法:基于新疆生产建设兵团维吾尔族人群队列,纳入11 833名研究对象。采用Kaplan-Meier法估计TyG及结合肥胖指标各四分位数组的CVD累积发生率;采用Cox比例风险回归模型评估TyG及结合肥胖指标与CVD发病的关系;采用弗雷明汉CVD风险评分模型(Framingham模型)评价TyG及结合肥胖指标加入是否可以改善模型预测能力;采用中介效应分析探讨肥胖与CVD发病关联中TyG的潜在中介作用。结果:研究对象年龄为(37.00±13.67)岁,51.0%为男性。队列中位随访时间为5.67年,新发CVD 1 288名。CVD累积发病率随TyG及结合肥胖指标四分位数升高而增加,与 Q1组相比,TyG、TyG-BMI和TyG-WHtR的 Q4组CVD发病风险分别增加20%( HR=1.20,95% CI:1.01~1.42)、77%( HR=1.77,95% CI:1.46~2.16)和68%( HR=1.68,95% CI:1.36~2.09)。TyG、TyG-BMI和TyG-WHtR分别加入Framingham模型后,模型曲线下面积、净重新分类指数和整体鉴别指数均有提升。BMI、WHtR与CVD发病关联中,通过TyG介导的中介效应比例为10.55%和11.50%。 结论:新疆生产建设兵团维吾尔族人群中,TyG及结合肥胖指标水平升高与CVD发病风险显著相关,以TyG-BMI与CVD关联最为密切。早期监测TyG-BMI有助于识别CVD高危人群。Objective To investigate the association of cardiovascular diseases(CVD)with triglyceride glucose index(TyG)and TyG-related indicators in Uyghur populations of The Xinjiang Production and Construction Corps.Methods Based on the cohort of the Uygur population of The Xinjiang Production and Construction Corps,11833 study subjects were included.The Kaplan-Meier method was used to estimate the cumulative incidence of CVD in each quartile of TyG and TyG-related indicators.Cox proportional hazards regression model was used to evaluate the relationship between TyG and CVD,TyG-related indicators and CVD.Framingham CVD risk score model(Framingham model)was used to evaluate whether the addition of TyG and TyG-related indicators could improve the predictive ability of the model.The potential mediating role of the TyG in the association between obesity and CVD was examined through mediation effect analysis.Results The average age of the subjects was(37.00±13.67)years-old,and 51.0%were male.The median follow-up time was 5.67 years,with 1288 CVD events.The cumulative incidence of CVD increased with the increase of TyG and TyG-related indicators quartiles,and compared with the Q1 group,the risk of CVD in the Q4 group of TyG,TyG-BMI,and TyG-WHtR increased by 20%(HR=1.20,95%CI:1.01-1.42),77%(HR=1.77,95%CI:1.46-2.16)and 68%(HR=1.68,95%CI:1.36-2.09),respectively.After adding TyG,TyG-BMI,and TyG-WHtR to the Framingham model,respectively,the model's area under the curve,net reclassification improvement,and integrated discrimination improvement were improved.In the association between BMI,WHtR,and CVD,the proportion of mediating effects mediated by the TyG index was 10.55%and 11.50%.Conclusions Elevated levels of TyG and TyG-related indicators were strongly associated with the risk of CVD in the Uyghur population of The Xinjiang Production and Construction Corps,with TyG-BMI being the most closely correlated with CVD.Early monitoring of TyG-BMI helps identify high-risk groups of CVD.

关 键 词：心血管疾病 队列研究 甘油三酯葡萄糖乘积指数 中介效应 

分 类 号：R589.2[医药卫生—内分泌] R54[医药卫生—内科学]