TyG指数及其结合肥胖指标与高血压人群新发心力衰竭的关联研究  

Association study of the triglyceride glucose index and its combined obesity indicators with incident heart failure in hypertensive population

作　　者：兑欣阳 马天佩 万洋 姜侠 龙璐 廖加强 樊萌语 汪川 陶成琳 章文强 瞿阳 胡琳 阳静 朱晨燕 袁璐 杜君 华西健康老龄与重大慢性病医防融合研究课题组 DUI Xin-yang;MA Tian-pei;WAN Yang;JIANG Xia;LONG Lu;LIAO Jia-qiang;FAN Meng-yu;WANG Chuan;TAO Cheng-lin;ZHANG Wen-qiang;QU Yang;HU Lin;YANG Jing;ZHU Chen-yang;YUAN Lu;DU Jun;Research Group on Health Aging and Integration of Major Chronic Disease Prevention,West China Hospital of Sichuan University(Department of Epidemiology and Health Statistics,West China School of Public Health,Sichuan University/West China Hospital of Sichuan University,Chengdu,Sichuan 610041,China;不详)

机构地区：[1]四川大学华西公共卫生学院/华西第四医院流行病与卫生统计学系,四川成都610041 [2]四川大学华西公共卫生学院/华西第四医院神经内科,四川成都610041 [3]成都市郫都区红光街道社区卫生服务中心

出　　处：《现代预防医学》2024年第17期3248-3253,共6页Modern Preventive Medicine

基　　金：国家重点研发计划项目课题(2022YFC3600600)。

摘　　要：目的探讨甘油三酯葡萄糖指数(triglyceride glucose index,TyG)及其结合肥胖指标的衍生指数(triglyceride glucose-body mass index,TyG-BMI;triglyceride glucose-waist circumference,TyG-WC;triglyceride glucose-waist-to-height ratio,TyG-WHtR)与高血压患者心力衰竭(heart failure)的相关性。方法以2017—2022年在成都市某社区卫生服务中心至少完成2次国家基本公共卫生服务健康体检的中老年(年龄≥35岁)高血压患者作为研究对象。采用多因素Cox比例风险回归模型评价TyG及其衍生指数与心力衰竭发生风险的关联。结果研究共纳入603名参与者,平均年龄(66.42±8.68)岁,其中40.8%为男性。中位随访时间为2.66年,34名患者新发心力衰竭。研究结果显示TyG-WHtR、TyG-WC、TyG-BMI及TyG指数与心力衰竭发病风险呈线性关联(PNonlinear>0.05)且每升高1个标准差,心力衰竭发病风险分别增加51.9%(HR=1.519,95%CI:1.050~2.200)、47.8%(HR=1.478,95%CI:1.013~2.156)、33.6%(HR=1.336,95%CI:0.944~1.892)和33.5%(HR=1.335,95%CI:0.900~1.981)。TyG衍生指数对心力衰竭的区分效果优于TyG指数,其中TyG-WHtR对心力衰竭发病的预测效果最好。结论应对中老年高血压人群开展TyG-WHtR指标监测,当TyG-WHtR≥3.62,心力衰竭发病风险显著增加,该指标有助于识别中老年高血压患者中心衰发病的高风险人群。Objective To investigate the correlation between the Triglyceride Glucose Index(TyG)and its derived indices combining obesity indicators—Triglyceride Glucose-Body Mass Index(TyG-BMI),Triglyceride Glucose-Waist Circumference(TyG-WC),and Triglyceride Glucose-Waist-to-Height Ratio(TyG-WHtR)—with the incidence of heart failure(HF)in hypertensive patients.Methods The study included middle-aged and elderly hypertensive patients(aged≥35 years)who completed at least two health check-ups as part of the national basic public health services at a community health service center in Chengdu from 2017 to 2022.A multivariable Cox proportional hazards regression model was employed to evaluate the association between TyG and its derived indices with the risk of HF occurrence.Results A total of 603 participants were included,with a mean age of 66.42±8.68 years,of which 40.8%were males.The median follow-up period was 2.66 years,during which 34 patients developed new-onset HF.The results indicated a linear association between TyG-WHtR,TyG-WC,TyG-BMI,and the TyG index with the risk of HF occurrence(PNonlinear>0.05).For each standard deviation increase,the risks of HF increased by 51.9%(HR=1.519,95%CI:1.050-2.200),47.8%(HR=1.478,95%CI:1.013-2.156),33.6%(HR=1.336,95%CI:0.944-1.892),and 33.5%(HR=1.335,95%CI:0.900-1.981),respectively.The derived indices of TyG demonstrated a better discriminatory ability for HF than the TyG index itself,with TyG-WHtR showing the best predictive effect for HF occurrence.Conclusion Monitoring the TyG-WHtR index in middle-aged and elderly hypertensive populations is recommended.When TyG-WHtR≥3.62,the risk of developing heart failure significantly increases,indicating that this index can help identify high-risk individuals for heart failure among hypertensive patients.

关 键 词：甘油三酯葡萄糖指数 心力衰竭 肥胖 胰岛素抵抗 

分 类 号：R544.1[医药卫生—心血管疾病] R541.9[医药卫生—内科学]