Ma Ning, Bai Liwei, Lu Qiang
Department of Endocrinology, First Hospital of Qinhuangdao, Hebei, Qinhuangdao, 066000, People's Republic of China.
Qinhuangdao Hospital for Maternal and Child Health, Hebei, Qinhuangdao, 066000, People's Republic of China.
Diabetes Metab Syndr Obes. 2024 Apr 8;17:1575-1583. doi: 10.2147/DMSO.S454826. eCollection 2024.
This study seeks to assess the potential of early pregnancy Triglyceride Glucose Index (TyG), triglyceride to High-Density Lipoprotein Cholesterol ratio (TG/HDL-c), Low-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol ratio (LDL-C/HDL-C), and Total Cholesterol to High-Density Lipoprotein Cholesterol ratio (TC/HDL-C) in predicting Gestational Diabetes Mellitus (GDM).
A total of 1073 adults singleton pregnant women were enrolled from June 2017 to September 2019. Complete anthropometric data and lipid profiles were measured in the first trimester (before 12 weeks gestation) and a 75g oral glucose tolerance test (OGTT) at 24-28 weeks was performed. Based on OGTT results, participants were categorised into Normal Glucose Tolerance (NGT) group (n=872) and GDM group (n=201). General data, laboratory test results, and surrogate insulin resistance indicators such as TyG index, TG/HDL-C, LDL-C/HDL-C, and TC/HDL-C were documented and compared. To compare differences between the two groups, test was used, Spearman correlation analysis and linear regression analysis were performed to establish associations between these indicators and insulin resistance in GDM. Receiver Operating Characteristic (ROC) curves were generated to compare the thresholds of these indicators for predicting GDM during pregnancy and to quantify overall diagnostic accuracy.
Individuals with GDM had higher TyG, TG/HDL-C, and LDL-C/HDL-C levels ( < 0.001), but with no significant difference observed in TC/HDL-C. All four ratios were positively correlated with Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), yet only TyG emerged as an independent risk factor for HOMA-IR. The Area under the Curve (AUC) of TyG index (0.692) was comparable to that of HOMA-IR (0.703). The cut-off points for TyG index, TG/HDL-C, and HOMA-IR in predicting GDM were 7.088, 0.831, and 1.8, respectively. HOMA-IR exhibited the highest sensitivity (79.1%), while TyG index (64.3%) and TG/HDL-C ratio (64.3%) demonstrated better specificity compared to HOMA-IR (56.3%). LDL-C/HDL-C and TC/HDL-C offered no discernible predictive advantage.
Early pregnancy TyG index and TG/HDL-C can aid in identifying pregnant women at risk for GDM, potentially facilitating early and effective intervention to improve prognosis. TyG index exhibited superior predictive capability compared to TG/HDL-C.
本研究旨在评估孕早期甘油三酯葡萄糖指数（TyG）、甘油三酯与高密度脂蛋白胆固醇比值（TG/HDL-c）、低密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值（LDL-C/HDL-C）以及总胆固醇与高密度脂蛋白胆固醇比值（TC/HDL-C）预测妊娠期糖尿病（GDM）的潜力。
2017年6月至2019年9月共纳入1073名单胎成年孕妇。在孕早期（妊娠12周前）测量完整的人体测量数据和血脂谱，并在24 - 28周进行75g口服葡萄糖耐量试验（OGTT）。根据OGTT结果，将参与者分为糖耐量正常（NGT）组（n = 872）和GDM组（n = 201）。记录并比较一般资料、实验室检查结果以及替代胰岛素抵抗指标，如TyG指数、TG/HDL-C、LDL-C/HDL-C和TC/HDL-C。为比较两组之间的差异，采用检验，进行Spearman相关性分析和线性回归分析，以建立这些指标与GDM中胰岛素抵抗之间的关联。绘制受试者工作特征（ROC）曲线，比较这些指标在孕期预测GDM的阈值，并量化总体诊断准确性。
GDM患者的TyG、TG/HDL-C和LDL-C/HDL-C水平较高（<0.001），但TC/HDL-C无显著差异。所有四个比值均与胰岛素抵抗稳态模型评估（HOMA-IR）呈正相关，但只有TyG成为HOMA-IR的独立危险因素。TyG指数的曲线下面积（AUC）（0.692）与HOMA-IR（0.703）相当。TyG指数、TG/HDL-C和HOMA-IR预测GDM的切点分别为7.088、0.831和1.8。HOMA-IR表现出最高的敏感性（79.1%），而TyG指数（64.3%）和TG/HDL-C比值（64.3%）与HOMA-IR（56.3%）相比具有更好的特异性。LDL-C/HDL-C和TC/HDL-C没有明显的预测优势。
孕早期TyG指数和TG/HDL-C有助于识别有GDM风险的孕妇，可能有助于早期有效干预以改善预后。TyG指数比TG/HDL-C表现出更好的预测能力。
