三酰甘油葡萄糖指数与老年人群新发心脏代谢性共病的相关性:前瞻性队列研究  

Association between Triglyceride-Glucose Index and Incident Cardiometabolic Multimorbidity in the Elderly:a Prospective Cohort Study

作　　者：陈巧巧 苏萍 赵颖颖 逄锦宏 施婕 王雅倩 李秋春 何蕊言 王玥 陈学禹 乔俊鹏 迟蔚蔚 CHEN Qiaoqiao;SU Ping;ZHAO Yingying;PANG Jinhong;SHI Jie;WANG Yaqian;LI Qiuchun;HE Ruiyan;WANG Yue;CHEN Xueyu;QIAO Junpeng;CHI Weiwei(School of Public Health,Cheeloo College of Medicine,Shandong University,Jinan 250012,China;National Institute of Health Data Science of China,Jinan 250003,China;National Administration of Health Data,Jinan 250002,China;Talent Development Center,Taizhou Medical High-tech Industrial Development Zone,Taizhou 225326,China)

机构地区：[1]山东大学齐鲁医学院公共卫生学院,山东省济南市250012 [2]国家健康医疗大数据研究院,山东省济南市250003 [3]山东健康医疗大数据管理中心,山东省济南市250002 [4]泰州医药高新技术产业开发区人才发展中心,江苏省泰州市225326

出　　处：《中国全科医学》2025年第18期2270-2277,共8页Chinese General Practice

基　　金：四大慢病重大专项(2023ZD0503500)。

摘　　要：背景现有研究广泛探讨了三酰甘油葡萄糖指数(TyG)与心脏代谢性疾病(CMD)的关联,而忽略了TyG与老年人群发生心脏代谢性共病(CMM)的相关性。目的本研究旨在探究老年人群中TyG与新发CMM的关联。方法采用前瞻性队列研究,选取齐鲁全生命周期电子健康研究型数据库(Cheeloo LEAD)2016年≥60岁的老年人群。以2016年为基线,研究终点事件为发生CMM或死亡,随访时间截至2022-12-31。根据基线TyG的四分位数将研究对象分为4组:Q1组(5.88≤TyG<8.22)、Q2组(8.22≤TyG<8.53)、Q3组(8.53≤TyG<8.90)、Q4组(8.90≤TyG<11.33)。绘制Kaplan-Meier生存曲线,采用Cox比例风险模型评估TyG对新发CMM风险的影响,并进行亚组分析和敏感性分析。采用限制性立方样条(RCS)曲线探究二者之间的关系。结果共15258例研究对象纳入分析,其中Q1组3875例、Q2组3776例、Q3组3840例、Q4组3767例。平均随访时间为5.63年,共随访85862.48人年,共有1328例(8.70%)新发CMM患者。Q1~Q4组新发CMM累积发病率分别为5.81%、7.65%、9.27%,12.16%,4组比较,差异有统计学意义(χ^(2)=104.300,P<0.001)。完全校正的Cox比例风险模型结果显示,与Q1相比,Q2、Q3、Q4组新发CMM的风险分别增加25.4%(HR=1.254,95%CI=1.052~1.494,P<0.05)、42.0%(HR=1.420,95%CI=1.196~1.686,P<0.001)、83.6%(HR=1.836,95%CI=1.535~2.195,P<0.001)。趋势性检验显示,TyG与新发CMM风险呈递增关系,该关联在对性别和BMI进行亚组分析及敏感性分析时持续存在(P<0.05)。RCS显示TyG与新发CMM风险之间呈剂量反应关系(P<0.001,P_(非线性)=0.175)。结论高TyG是老年人群新发CMM的独立危险因素,且两者之间存在剂量反应关系。随着TyG水平的升高,新发CMM风险递增,高TyG水平显著增加老年人群CMM的发病风险,尤其在男性、MBI较高的群体中更为显著。控制TyG水平对于老年人群的疾病预防具有重要作用。Background Existing studies have extensively explored the association between the triglyceride-glucose index(TyG)and cardiometabolic diseases(CMD),while the relationship between TyG and the occurrence of cardiometabolic multimorbidity(CMM)in the elderly population has been overlooked.Objective This study aims to investigate the association between TyG and the incidence of CMM in the elderly population.Methods A prospective cohort study was conducted using the Cheeloo Lifetime Electronic Health Database(Cheeloo LEAD),selecting elderly individuals aged≥60 years in 2016.Using 2016 as the baseline,the study endpoints were defined as the occurrence of CMM or death,with the follow-up period lasting until December 31,2022.Participants were divided into four groups based on the quartiles of the baseline TyG:Q1(5.88≤TyG<8.22),Q2(8.22≤TyG<8.53),Q3(8.53≤TyG<8.90),and Q4(8.90≤TyG<11.33).Kaplan-Meier survival curves were plotted,and Cox proportional hazards models were used to assess the impact of TyG on the risk of incident CMM.Subgroup and sensitivity analyses were also conducted.Restrictive cubic splines(RCS)were applied to explore the relationship between TyG and CMM.Results A total of 15258 participants were included in the analysis,with 3875 in the Q1 group,3776 in the Q2 group,3840 in the Q3 group,and 3767 in the Q4 group.The average follow-up time was 5.63 years,totaling 85862.48 person-years of follow-up.There were 1328 new cases of CMM(8.70%).The cumulative incidence rates of new CMM in the Q1-Q4 groups were 5.81%,7.65%,9.27%,and 12.16%,respectively.The comparison of CMM incidence rates among the four groups showed statistically significant differences(χ^(2)=104.300,P<0.001).The results of the fully adjusted Cox proportional hazards model showed that,compared to the Q1 group,the risk of incident CMM in the Q2,Q3,and Q4 groups increased by 25.4%(HR=1.254,95%CI=1.052-1.494,P<0.05),42.0%(HR=1.420,95%CI=1.196-1.686,P<0.001),and 83.6%(HR=1.836,95%CI=1.535-2.195,P<0.001),respectively.The trend test in the Cox m

关 键 词：心脏代谢性共病 代谢性心血管综合征 三酰甘油葡萄糖指数 老年人 山东省 队列研究 前瞻性研究 生存分析 

分 类 号：R589[医药卫生—内分泌]