TyG 指数与非酒精性脂肪性肝病患者 CHD 风险和冠状动脉粥样硬化严重程度呈正相关。
TyG index is positively associated with risk of CHD and coronary atherosclerosis severity among NAFLD patients.
机构信息
Department of Cardiology, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, Shanxi, China.
Department of Neurology, The Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, 030001, Shanxi, China.
出版信息
Cardiovasc Diabetol. 2022 Jul 1;21(1):123. doi: 10.1186/s12933-022-01548-y.
BACKGROUND
Insulin resistance (IR), endothelial dysfunction, inflammation, glucose and lipid metabolism disorders, and thrombosis are believed involved in coronary heart disease (CHD) and non-alcoholic fatty liver disease (NAFLD). Triglyceride-glucose (TyG) index, a new IR indicator, is correlated with NAFLD occurrence and severity, but its relationship with CHD risk remains unclear. This study investigated the correlation between TyG index and CHD risk among NAFLD patients.
METHODS
This cross-sectional study included 424 patients with NAFLD and chest pain in the Department of Cardiology, The Second Hospital of Shanxi Medical University, from January 2021 to December 2021. The TyG index was calculated and coronary angiography performed. All individuals were divided into NAFLD + CHD and NAFLD groups and then by TyG index level. The t-test, Mann-Whitney U-test, or one-way analysis of variance compared differences in continuous variables, while the chi-square test or Fisher's exact test compared differences in categorical variables. Logistic regression analysis determined the independent protective or hazardous factors of NAFLD with CHD. The receiver operating characteristic curve evaluated the ability of different TyG index rule-in thresholds to predict CHD. The relationship between Gensini score and TyG index was evaluated using linear correlation and multiple linear regression.
RESULTS
CHD was detected in 255 of 424 patients. Compared to NAFLD group, multivariate logistic regression showed that TyG index was a risk factor for CHD among NAFLD patients after adjustment for age, sex, hypertension, and diabetes mellitus with the highest odds ratio (OR, 2.519; 95% CI, 1.559-4.069; P < 0.001). TG, low-density lipoprotein cholesterol, FBG and TYG-body mass index were also risk factors for CHD among NAFLD patients. High-density lipoprotein cholesterol level was a protective factor for CHD events in patients with NAFLD. In an in-depth analysis, multivariate logistic regression analysis showed that each 1-unit increase in TyG index was associated with a 2.06-fold increased risk of CHD (OR, 2.06; 95% CI, 1.16-3.65; P = 0.013). The multifactor linear regression analysis showed each 0.1-unit increase in TyG in the NAFLD-CHD group was associated with a 2.44 increase in Gensini score (β = 2.44; 95% CI, 0.97-3.91; P = 0.002).
CONCLUSIONS
The TyG index was positively correlated with CHD risk in NAFLD patients and reflected coronary atherosclerosis severity.
背景
胰岛素抵抗（IR）、内皮功能障碍、炎症、葡萄糖和脂质代谢紊乱以及血栓形成被认为与冠心病（CHD）和非酒精性脂肪肝（NAFLD）有关。甘油三酯-葡萄糖（TyG）指数是一种新的 IR 指标，与 NAFLD 的发生和严重程度相关，但与 CHD 风险的关系尚不清楚。本研究旨在探讨 TyG 指数与 NAFLD 患者 CHD 风险之间的相关性。
方法
本横断面研究纳入了 2021 年 1 月至 2021 年 12 月在山西医科大学第二医院心内科就诊的 424 例有胸痛症状的 NAFLD 患者。计算 TyG 指数并进行冠状动脉造影。所有患者均分为 NAFLD+CHD 组和 NAFLD 组，并按 TyG 指数水平进一步分组。采用 t 检验、Mann-Whitney U 检验或单因素方差分析比较连续变量的差异，采用卡方检验或 Fisher 确切概率法比较分类变量的差异。采用 logistic 回归分析确定与 NAFLD 合并 CHD 相关的独立保护或危险因素。采用受试者工作特征曲线（ROC 曲线）评估不同 TyG 指数截断值预测 CHD 的能力。采用线性相关和多元线性回归评估 Gensini 评分与 TyG 指数之间的关系。
结果
424 例患者中 255 例检测出 CHD。多因素 logistic 回归显示，在校正年龄、性别、高血压和糖尿病后，TyG 指数是 NAFLD 患者发生 CHD 的危险因素，其比值比（OR）最高（2.519；95%置信区间，1.559-4.069；P<0.001）。甘油三酯、低密度脂蛋白胆固醇、空腹血糖和 TyG-体重指数也是 NAFLD 患者发生 CHD 的危险因素。高密度脂蛋白胆固醇水平是 NAFLD 患者 CHD 事件的保护因素。进一步分析显示，多因素 logistic 回归分析显示，TyG 指数每增加 1 个单位，CHD 风险增加 2.06 倍（OR，2.06；95%置信区间，1.16-3.65；P=0.013）。多元线性回归分析显示，NAFLD-CHD 组中 TyG 每增加 0.1 个单位，Gensini 评分增加 2.44 分（β=2.44；95%置信区间，0.97-3.91；P=0.002）。
结论
TyG 指数与 NAFLD 患者的 CHD 风险呈正相关，反映了冠状动脉粥样硬化的严重程度。
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