Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX.
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Chest. 2021 Sep;160(3):1026-1034. doi: 10.1016/j.chest.2021.03.056. Epub 2021 Apr 8.
Metabolic syndrome and insulin resistance are associated with worsened outcomes of chronic lung disease. The triglyceride-glucose index (TyG), a measure of metabolic dysfunction, is associated with metabolic syndrome and insulin resistance, but its relationship to lung health is unknown.
What is the relationship of TyG to respiratory symptoms, chronic lung disease, and lung function?
This study analyzed data from the National Health and Nutrition Examination Survey from 1999 to 2012. Participants included fasting adults age ≥ 40 years (N = 6,893) with lung function measurements in a subset (n = 3,383). Associations of TyG with respiratory symptoms (cough, phlegm production, wheeze, and exertional dyspnea), chronic lung disease (diagnosed asthma, chronic bronchitis, and emphysema), and lung function (FEV, FVC, and obstructive or restrictive spirometry pattern) were evaluated, adjusting for sociodemographic variables, comorbidities, and smoking. TyG was compared vs insulin resistance, represented by the homeostatic model assessment of insulin resistance (HOMA-IR), and vs the metabolic syndrome.
TyG was moderately correlated with HOMA-IR (Spearman ρ = 0.51) and had good discrimination for metabolic syndrome (area under the receiver-operating characteristic curve, 0.80). A one-unit increase in TyG was associated with higher odds of cough (adjusted OR [aOR], 1.28; 95% CI, 1.06-1.54), phlegm production (aOR, 1.20; 95% CI, 1.01-1.43), wheeze (aOR, 1.18; 95% CI, 1.03-1.35), exertional dyspnea (aOR, 1.21; 95% CI, 1.07-1.38), and a diagnosis of chronic bronchitis (aOR, 1.21; 95% CI, 1.02-1.43). TyG was associated with higher relative risk of a restrictive spirometry pattern (adjusted relative risk ratio, 1.45; 95% CI, 1.11-1.90). Many associations were maintained with additional adjustment for HOMA-IR or metabolic syndrome.
TyG was associated with respiratory symptoms, chronic bronchitis, and a restrictive spirometry pattern. Associations were not fully explained by insulin resistance or metabolic syndrome. TyG is a satisfactory measure of metabolic dysfunction with relevance to pulmonary outcomes. Prospective study to define TyG as a biomarker for impaired lung health is warranted.
代谢综合征和胰岛素抵抗与慢性肺部疾病的不良预后有关。三酰甘油-葡萄糖指数（TyG）是衡量代谢功能障碍的指标，与代谢综合征和胰岛素抵抗有关，但与肺部健康的关系尚不清楚。
TyG 与呼吸系统症状、慢性肺部疾病和肺功能有什么关系？
本研究分析了 1999 年至 2012 年全国健康与营养调查的数据。参与者包括年龄≥40 岁的空腹成年人（N=6893），其中一部分（n=3383）进行了肺功能测量。评估了 TyG 与呼吸系统症状（咳嗽、咳痰、喘息和劳力性呼吸困难）、慢性肺部疾病（诊断为哮喘、慢性支气管炎和肺气肿）和肺功能（FEV、FVC 和阻塞性或限制性肺功能检查模式）的关系，调整了社会人口统计学变量、合并症和吸烟情况。将 TyG 与胰岛素抵抗（代表稳态模型评估的胰岛素抵抗（HOMA-IR））和代谢综合征进行了比较。
TyG 与 HOMA-IR 中度相关（Spearman ρ=0.51），对代谢综合征有良好的区分度（受试者工作特征曲线下面积，0.80）。TyG 增加一个单位与咳嗽（调整后的优势比[OR]，1.28；95%置信区间[CI]，1.06-1.54）、咳痰（调整后的 OR，1.20；95%CI，1.01-1.43）、喘息（调整后的 OR，1.18；95%CI，1.03-1.35）、劳力性呼吸困难（调整后的 OR，1.21；95%CI，1.07-1.38）和慢性支气管炎（调整后的 OR，1.21；95%CI，1.02-1.43）的发生几率更高。TyG 与限制性肺功能检查模式的相对风险比（调整后的相对风险比，1.45；95%CI，1.11-1.90）升高有关。许多关联在进一步调整 HOMA-IR 或代谢综合征后仍然存在。
TyG 与呼吸系统症状、慢性支气管炎和限制性肺功能检查模式有关。这些关联不能完全用胰岛素抵抗或代谢综合征来解释。TyG 是衡量与肺部结局相关的代谢功能障碍的一个满意指标。需要进行前瞻性研究以确定 TyG 是否为肺功能受损的生物标志物。
