Diabetes Centre, 609710Admiralty Medical Centre, Singapore.
Clinical Research Unit, 150819Khoo Teck Puat Hospital, Singapore.
Diab Vasc Dis Res. 2022 Jul-Aug;19(4):14791641221113784. doi: 10.1177/14791641221113784.
Triglyceride-glucose (TyG) index is a surrogate marker of insulin resistance. Its role in chronic kidney disease (CKD) progression in Type 2 Diabetes Mellitus (T2DM) is unclear. We investigated the association between TyG index and CKD progression, and possible mediation of the association by pigment epithelium-derived factor (PEDF).
This was a prospective study on 1571 patients with T2DM. CKD progression was defined as worsening across KDIGO estimated glomerular filtration rate (eGFR) categories with ≥25% reduction from baseline. PEDF was quantitated using enzyme-linked immunosorbent assay method. Cox proportional hazards regression model was used to assess the relationship between TyG index and CKD progression.
Over a follow-up period of up to 8.6 years (median 4.6 years, IQR 3.0-3.6), 42.7% of subjects had CKD progression. Every unit increase in TyG was associated with hazards of 1.44 (95%CI 1.29-1.61; < 0.001) in unadjusted analysis and 1.21 (1.06-1.37; = 0.004) in fully adjusted model. Compared to tertile 1, tertiles 2 and 3 TyG index were positively associated with CKD progression with corresponding hazard ratios HRs 1.24 (1.01-1.52; = 0.037) and 1.37 (1.11-1.68; = 0.003) in fully adjusted models. PEDF accounted for 36.0% of relationship between TyG index and CKD progression.
Higher TyG index independently predicted CKD progression in T2DM. PEDF mediated the association between TyG index and CKD progression.
甘油三酯-葡萄糖（TyG）指数是胰岛素抵抗的替代标志物。其在 2 型糖尿病（T2DM）慢性肾脏病（CKD）进展中的作用尚不清楚。我们研究了 TyG 指数与 CKD 进展之间的关系，以及色素上皮衍生因子（PEDF）对这种关系的可能介导作用。
这是一项针对 1571 例 T2DM 患者的前瞻性研究。CKD 进展定义为根据 KDIGO 估计肾小球滤过率（eGFR）类别恶化，与基线相比下降≥25%。PEDF 采用酶联免疫吸附测定法定量。Cox 比例风险回归模型用于评估 TyG 指数与 CKD 进展之间的关系。
在长达 8.6 年的随访期间（中位数 4.6 年，IQR 3.0-3.6），42.7%的患者发生 CKD 进展。未经调整分析中，TyG 每增加一个单位，发生风险为 1.44（95%CI 1.29-1.61；<0.001），完全调整模型中为 1.21（1.06-1.37；=0.004）。与第 1 三分位相比，第 2 和第 3 三分位 TyG 指数与 CKD 进展呈正相关，相应的风险比（HR）分别为 1.24（1.01-1.52；=0.037）和 1.37（1.11-1.68；=0.003）在完全调整模型中。PEDF 占 TyG 指数与 CKD 进展之间关系的 36.0%。
较高的 TyG 指数独立预测了 T2DM 患者的 CKD 进展。PEDF 介导了 TyG 指数与 CKD 进展之间的关系。
