甘油三酯/高密度脂蛋白胆固醇比值和脂蛋白胰岛素抵抗评分：与亚临床动脉粥样硬化和心血管疾病事件的关系。
Triglyceride/HDL cholesterol ratio and lipoprotein insulin resistance Score: Associations with subclinical atherosclerosis and incident cardiovascular disease.
机构信息
Interdisciplinary Center for Research and Science Education, Autonomous University of Puebla, Puebla, Mexico.
Department of Internal Medicine, Division of Endocrinology, University Medical Center Groningen, University of Groningen, the Netherlands.
出版信息
Clin Chim Acta. 2024 Jan 15;553:117737. doi: 10.1016/j.cca.2023.117737. Epub 2023 Dec 22.
BACKGROUND
The triglyceride/HDL cholesterol (TG/HDL-C) ratio and the Lipoprotein Insulin Resistance (LP-IR) score are lipid markers of insulin resistance. Their associations with carotid intima media thickness (cIMT; subclinical atherosclerosis) and incident cardiovascular disease (CVD) have not been thoroughly investigated.
METHODS
In a cross-sectional cohort (89 subjects without type 2 diabetes (T2D) and 81 subjects with T2D we determined cIMT (ultrasound), homeostasis model assessment of insulin resistance (HOMA-IR) and the TG/HDL-C ratio. The LP-IR score, based on 6 lipoprotein characteristics determined by nuclear magnetic resonance spectroscopy, was measured in 123 participants. A prospective study was carried out among 6232 participants (Prevention of REnal and Vascular ENd-stage Disease study).
RESULTS
Cross-sectionally, the adjusted associations of HOMA-IR, the TG/HDL-C ratio and the LP-IR score with cIMT were approximately similar (standardized β = 0.34 (95 % CI 0.19-0.48), 0.24 (95 % CI 0.09-039) and 0.41 (95 % CI 0.23--0.59), respectively). Prospectively, 507 new cases of CVD were observed after a median follow-up of 8.2 (interquartile range 7.5-8.8) years. HOMA-IR, the TG/HDL-C ratio and LP-IR were each associated with incident CVD independent of potential confounders (HR 1.12, 95 % CI 1.02-1.24;1.22, 95 % CI 1.11-1.35 and 1.15. 95 % CI 1.01-1.31, respectively). The association of the TG/HDL-C ratio with incident CVD was somewhat stronger than that of HOMA-IR.
CONCLUSION
Lipoprotein-based markers of insulin resistance are at least as strongly associated with subclinical atherosclerosis and clinical atherosclerosis development as HOMA-IR, obviating the need to measure insulin to determine the impact of insulin resistance. For practical purposes, the easily obtainable TG/HDL-C ratio may suffice.
背景
甘油三酯/高密度脂蛋白胆固醇（TG/HDL-C）比值和脂蛋白胰岛素抵抗（LP-IR）评分是胰岛素抵抗的脂质标志物。它们与颈动脉内膜中层厚度（cIMT；亚临床动脉粥样硬化）和心血管疾病（CVD）事件的关系尚未得到彻底研究。
方法
在一项横断面队列研究中（89 名无 2 型糖尿病（T2D）患者和 81 名 T2D 患者），我们测定了 cIMT（超声）、稳态模型评估的胰岛素抵抗（HOMA-IR）和 TG/HDL-C 比值。在 123 名参与者中测量了基于核磁共振波谱法测定的 6 种脂蛋白特征的 LP-IR 评分。在 6232 名参与者中进行了一项前瞻性研究（预防肾脏和血管终末期疾病研究）。
结果
横断面研究中，HOMA-IR、TG/HDL-C 比值和 LP-IR 评分与 cIMT 的调整后相关性大致相似（标准化β=0.34（95%CI 0.19-0.48）、0.24（95%CI 0.09-0.39）和 0.41（95%CI 0.23-0.59））。前瞻性研究中，中位随访 8.2 年后（四分位间距 7.5-8.8 年）观察到 507 例新的 CVD 病例。HOMA-IR、TG/HDL-C 比值和 LP-IR 与 CVD 事件的发生均独立于潜在混杂因素相关（HR 1.12，95%CI 1.02-1.24；1.22，95%CI 1.11-1.35 和 1.15，95%CI 1.01-1.31）。与 HOMA-IR 相比，TG/HDL-C 比值与 CVD 事件的相关性稍强。
结论
脂蛋白为基础的胰岛素抵抗标志物与亚临床动脉粥样硬化和临床动脉粥样硬化发展的相关性至少与 HOMA-IR 一样强，无需测量胰岛素即可确定胰岛素抵抗的影响。出于实际目的，易于获得的 TG/HDL-C 比值可能就足够了。
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