不同糖代谢状态下TyG指数对慢性肾脏病患者冠心病发生风险的评估价值  

The predictive value of TyG Index for coronary heart disease risk in patients with chronic kidney disease under different glycometabolic states

作　　者：丁云云 汪小五 武东 王伟 刘艳 李梅 李团团 DING Yunyun;WANG Xiaowu;WU Dong;WANG Wei;LIU Yan;LI Mei;LI Tuantuan(Department of Clinical Laboratory,the Second People′s Hospital of Fuyang,Fuyang,Anhui 236000,China;Department of Pharmacy,Fuyang People′s Hospital,Fuyang,Anhui 236000,China;Department of Clinical Laboratory,Fuyang People′s Hospital,Fuyang,Anhui 236000,China)

机构地区：[1]安徽省阜阳市第二人民医院检验科,安徽阜阳236000 [2]安徽省阜阳市人民医院药剂科,安徽阜阳236000 [3]安徽省阜阳市人民医院检验科,安徽阜阳236000

出　　处：《检验医学与临床》2024年第21期3161-3167,共7页Laboratory Medicine and Clinic

基　　金：安徽省卫生健康委员会科研立项青年项目(AHWJ2023A30162)。

摘　　要：目的探讨不同糖代谢状态下甘油三酯葡萄糖乘积(TyG)指数对慢性肾脏病(CKD)患者冠心病(CHD)发生风险的评估价值。方法选取2021年6月至2023年12月在阜阳市第二人民医院住院的CKD患者307例为研究对象。根据是否合并CHD分为CKD合并CHD组(CHD组)130例,CKD不合并CHD组(非CHD组)177例。根据是否合并糖尿病进行分层:糖尿病患者中CHD组59例,非CHD组65例;无糖尿病患者中CHD组71例,非CHD组112例。绘制受试者工作特征(ROC)曲线分析不同糖代谢状态下TyG指数、空腹血糖(GLU)、空腹甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、纤维蛋白原(FIB)对CHD发生风险的评估价值,采用多因素二元Logistic回归分析CKD患者发生CHD的危险因素。结果在糖尿病患者中,CHD组年龄、TyG指数以及GLU、TG水平高于非CHD组(P<0.05),HDL-C水平低于非CHD组(P<0.05);TyG指数、GLU、TG、HDL-C预测CKD患者发生CHD的曲线下面积(AUC)分别为0.820(95%CI:0.741~0.883)、0.676(95%CI:0.586~0.757)、0.717(95%CI:0.630~0.795)、0.666(95%CI:0.576~0.749);多因素二元Logistic回归分析发现,年龄增大、TyG指数升高是糖尿病CKD患者发生CHD的独立危险因素(OR=1.092、6.200,P<0.05)。在无糖尿病患者中,CHD组年龄、患有高血压的比例、TyG指数,以及GLU、TG、FIB水平高于非CHD组(P<0.05),HDL-C水平低于非CHD组(P<0.05),TyG指数、GLU、TG、HDL-C、FIB预测CKD患者发生CHD的AUC为0.898(95%CI:0.845~0.938)、0.653(95%CI:0.579~0.721)、0.823(95%CI:0.760~0.875)、0.618(95%CI:0.544~0.689)、0.688(95%CI:0.615~0.754);多因素二元Logistic回归分析发现,年龄增大、患有高血压、TyG指数升高、FIB水平升高是无糖尿病CKD患者发生CHD的独立危险因素(OR=1.120、19.674、48.002、1.999,P<0.05)。结论TyG指数、GLU、TG、HDL-C、FIB与CKD患者发生CHD均有一定的关系,且TyG指数的风险评估价值最高。Objective To investigate the predictive value of triglyceride-glucose(TyG)index for the risk of coronary heart disease(CHD)in patients with chronic kidney disease(CKD)under different glycometabolic states.Methods A total of 307 patients with CKD hospitalized at the Second People′s Hospital of Fuyang from June 2021 to December 2023 were selected for this study.According to the presence of coronary heart disease(CHD),they were divided into the CKD with CHD group(CHD group,130 cases)and CKD without CHD group(non-CHD group,177 cases).Further stratification was performed based on diabetes status:59 patients with diabetes in the CHD group and 65 in the non-CHD group;71 non-diabetic patients in the CHD group and 112 in the non-CHD group.Receiver operating characteristic(ROC)curve was drawn to assess the predictive value of the TyG index,fasting glucose(GLU),fasting triglycerides(TG),high-density lipoprotein cholesterol(HDL-C)and fibrinogen(FIB)for CHD risk in different glycometabolic states.Multivariate binary Logistic regression analysis was used to analyze risk factors for CHD in CKD patients.Results In diabetic patients,those in the CHD group had significantly higher age,TyG index,and levels of GLU and TG compared with the non-CHD group(P<0.05),while HDL-C level was significantly lower(P<0.05).The area under the curve(AUC)for predicting CHD in CKD patients using TyG index,GLU,TG and HDL-C were 0.820(95%CI:0.741-0.883),0.676(95%CI:0.586-0.757),0.717(95%CI:0.630-0.795)and 0.666(95%CI:0.576-0.749)respectively.Multivariate binary Logistic regression revealed that increasing age and a higher TyG index were independent risk factors for diabetic CHD in CKD patients(OR=1.092,6.200,P<0.05).In non-diabetic patients,the CHD group had higher age,a greater proportion of hypertension,and elevated levels of TyG index,GLU,TG and FIB compared with the non-CHD group(P<0.05),while HDL-C level was lower(P<0.05).The AUC for predicting CHD in CKD patients using TyG index,GLU,TG,HDL-C and FIB were 0.898(95%CI:0.845-0.938),0.653(95%CI:0.5

关 键 词：慢性肾脏疾病 冠心病 甘油三酯葡萄糖乘积指数 二元LOGISTIC回归 受试者工作特征曲线 

分 类 号：R541.4[医药卫生—心血管疾病] R446.1[医药卫生—内科学]