Martinez-Urbistondo Diego, D'Avola Delia, Navarro-González David, Sanchez-Iñigo Laura, Fernandez-Montero Alejandro, Perez-Diaz-Del-Campo Nuria, Bugianesi Elisabetta, Martinez Jose Alfredo, Pastrana Juan Carlos
Internal Medicine Department, Clínica Universidad de Navarra, 28027 Madrid, Spain.
Liver Unit, Clínica Universidad de Navarra, 28027 Madrid, Spain.
J Clin Med. 2022 Sep 1;11(17):5190. doi: 10.3390/jcm11175190.
: The combination of easy-to-obtain validated biomarkers is interesting in the prognostic evaluation of patients at cardiovascular risk in a precision medicine scenario. The evaluation of the effect modification of insulin resistance and liver fibrosis with the Triglyceride-Glucose index (TyG) and Fibrosis-4 index (FIB4) might provide prognostic information in patients at cardiovascular risk. A retrospective cohort study was performed with 2055 patients recruited in the Vascular Metabolic CUN cohort. The studied outcome was the incidence rate of major cardiovascular events (MACE). The Systematic Coronary Risk Evaluation (SCORE), FIB4 and TyG indexes were calculated according to validated formulas. FIB4 and TyG showed a synergistic interaction using validated cut-offs for both indexes in the prediction of MACE (Hazard ratio (HR) 1.05 CI95% 1.01-1.08) which remained after adjustment by age, sex, SCORE subgroup, presence of diabetes, or previous MACE using standardized cut-off (HR 2.29 CI95% 1.33-3.94). Finally, a subgroup with significant TyG and FIB4 showed a higher cardiovascular risk in the study population (adjusted HR 3.34 CI 95% 1.94-5.77). The combined interpretation of TyG and FIB4 indexes might have a potential predictive value of major cardiovascular events.
在精准医学背景下，易于获得的经过验证的生物标志物组合对于心血管疾病风险患者的预后评估具有重要意义。通过甘油三酯-葡萄糖指数（TyG）和纤维化-4指数（FIB4）评估胰岛素抵抗和肝纤维化的效应修饰，可能为心血管疾病风险患者提供预后信息。我们对血管代谢CUN队列中招募的2055例患者进行了一项回顾性队列研究。研究的结局是主要心血管事件（MACE）的发生率。根据经过验证的公式计算系统性冠状动脉风险评估（SCORE）、FIB4和TyG指数。在预测MACE时，FIB4和TyG在使用两个指数的验证临界值时显示出协同相互作用（风险比（HR）1.05，95%置信区间1.01-1.08），在按年龄、性别、SCORE亚组、糖尿病存在情况或既往MACE使用标准化临界值进行调整后，该相互作用仍然存在（HR 2.29，95%置信区间1.33-3.94）。最后，TyG和FIB4显著的亚组在研究人群中显示出更高的心血管风险（调整后HR 3.34，95%置信区间1.94-5.77）。TyG和FIB4指数的联合解读可能对主要心血管事件具有潜在的预测价值。
