三酰甘油-葡萄糖（TyG）指数对急性失代偿性心力衰竭患者的预后价值。
Prognostic value of triglyceride glucose (TyG) index in patients with acute decompensated heart failure.
机构信息
Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China.
Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, 210008, Jiangsu, China.
出版信息
Cardiovasc Diabetol. 2022 May 31;21(1):88. doi: 10.1186/s12933-022-01507-7.
BACKGROUND
The triglyceride glucose (TyG) index has been proposed as a reliable marker of insulin resistance (IR) and an independent predictor of cardiovascular disease risk. However, its prognostic value in patients with acute decompensated heart failure (ADHF) remains unclear.
METHODS
A total of 932 hospitalized patients with ADHF from January 1st, 2018 to February 1st, 2021 were included in this retrospective study. The TyG index was calculated as ln [fasting triglyceride level (mg/dL) × fasting plasma glucose level (mg/dL)/2]. Patients were divided into tertiles according to TyG index values. The primary endpoints were all-cause death, cardiovascular (CV) death and major adverse cardiac and cerebral events (MACCEs) during follow-up. We used multivariate adjusted Cox proportional hazard models and restricted cubic spline analysis to investigate the associations of the TyG index with primary endpoints.
RESULTS
During a median follow-up time of 478 days, all-cause death, CV death and MACCEs occurred in 140 (15.0%), 103 (11.1%) and 443 (47.9%) cases, respectively. In multivariate Cox proportional hazard models, the risk of incident primary endpoints was associated with the highest TyG tertile. After adjustment for confounding factors, hazard ratios (HRs) for the highest tertile (TyG index ≥ 9.32) versus the lowest tertile (TyG index < 8.83) were 2.09 (95% confidence interval [CI], 1.23-3.55; p = 0.006) for all-cause death, 2.31 (95% CI, 1.26-4.24; p = 0.007) for CV death and 1.83 (95% CI, 1.18-3.01; p = 0.006) for MACCEs. Restricted cubic spline analysis also showed that the cumulative risk of primary endpoints increased as TyG index increased. When the TyG index was used as a continuous variable, the hazard ratios of the three primary endpoints rapidly increased within the higher range of the TyG index (all cause death, TyG > 9.08; CV death, TyG > 9.46; MACCEs, TyG > 9.87).
CONCLUSIONS
The elevated TyG index was independently associated with poor prognosis, and thus would be useful in the risk stratification in patients with ADHF.
背景
甘油三酯-葡萄糖（TyG）指数已被提出作为胰岛素抵抗（IR）的可靠标志物，并且是心血管疾病风险的独立预测因子。然而，其在急性失代偿性心力衰竭（ADHF）患者中的预后价值尚不清楚。
方法
本回顾性研究纳入了 2018 年 1 月 1 日至 2021 年 2 月 1 日期间住院的 932 例 ADHF 患者。TyG 指数的计算方法为 ln[空腹甘油三酯水平（mg/dL）×空腹血糖水平（mg/dL）/2]。根据 TyG 指数值将患者分为三分位组。主要终点是随访期间的全因死亡、心血管（CV）死亡和主要不良心脏和脑血管事件（MACCEs）。我们使用多变量调整的 Cox 比例风险模型和限制立方样条分析来研究 TyG 指数与主要终点的关联。
结果
在中位随访时间为 478 天期间，全因死亡、CV 死亡和 MACCEs 分别发生在 140 例（15.0%）、103 例（11.1%）和 443 例（47.9%）患者中。在多变量 Cox 比例风险模型中，发生主要终点事件的风险与 TyG 最高三分位组相关。在校正混杂因素后，TyG 最高三分位组（TyG 指数≥9.32）与最低三分位组（TyG 指数<8.83）相比，全因死亡的风险比（HR）为 2.09（95%置信区间[CI]，1.23-3.55；p=0.006），CV 死亡的 HR 为 2.31（95% CI，1.26-4.24；p=0.007），MACCEs 的 HR 为 1.83（95% CI，1.18-3.01；p=0.006）。限制立方样条分析还表明，随着 TyG 指数的增加，主要终点的累积风险增加。当 TyG 指数作为连续变量时，三个主要终点的 HR 在 TyG 指数较高范围内迅速增加（全因死亡，TyG>9.08；CV 死亡，TyG>9.46；MACCEs，TyG>9.87）。
结论
升高的 TyG 指数与不良预后独立相关，因此可用于 ADHF 患者的风险分层。
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