美国非酒精性脂肪性肝病患者中估计葡萄糖处置率与动脉僵硬度和死亡率之间的关系。

Associations between estimated glucose disposal rate and arterial stiffness and mortality among US adults with non-alcoholic fatty liver disease.

机构信息

Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China.

Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China.

出版信息

Front Endocrinol (Lausanne). 2024 May 8;15:1398265. doi: 10.3389/fendo.2024.1398265. eCollection 2024.

BACKGROUND

The estimated glucose disposal rate (eGDR), an effective indicator of insulin resistance, has been related to acute coronary syndrome, ischemic stroke and heart failure. This study aims to explore the relationship between eGDR and arterial stiffness, all-cause mortality and cardiovascular mortality in patients with non-alcoholic fatty liver disease (NAFLD).

METHODS

Participants with NAFLD were chosen from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018. The main outcomes are arterial stiffness (represented by estimated pulse wave velocity, ePWV), all-cause and cardiovascular mortality. Multiple cox regression models, restricted cubic spline, sensitivity analysis and subgroup analysis were carried out to investigate the correlation between the insulin resistance indicators and mortality and arterial stiffness. Furthermore, receiver operating characteristic curves were used to compare the predictive value of the eGDR with the triglyceride-glucose (TyG) index and the homeostasis model assessment of insulin resistance (HOMA-IR) for all-cause and cardiovascular mortality.

RESULTS

In this study, a total of 4,861 participants were included for analysis. After adjusting confounding factors in the multivariate weighted cox regression model, the eGDR was inversely associated with the all-cause mortality (Q4 vs. Q1, HR =0.65 (0.48-0.89, P=0.01) and cardiovascular mortality (Q4 vs. Q1, HR =0.35 (0.19-0.65, P<0.001). Compared with TyG index and HOMA-IR, the eGDR shows excellent predictive value in all-cause mortality (0.588 vs. 0.550 vs. 0.513, P < 0.001) and cardiovascular mortality (0.625 vs. 0.553 vs. 0.537, P < 0.001). In addition, we found a significant negative correlation between eGDR and arterial stiffness (β=-0.13(-0.14-0.11, P< 0.001). However, TyG index and HOMA-IR showed no significant correlation to arterial stiffness.

CONCLUSIONS

Low eGDR (an indicator of insulin resistance) levels are related to an increased risk of arterial stiffness and mortality in NAFLD patients in the United States.

背景

估计葡萄糖处置率（eGDR）是胰岛素抵抗的有效指标，与急性冠状动脉综合征、缺血性卒中和心力衰竭有关。本研究旨在探讨非酒精性脂肪性肝病（NAFLD）患者的 eGDR 与动脉僵硬度、全因死亡率和心血管死亡率之间的关系。

方法

本研究从 1999 年至 2018 年的全国健康和营养检查调查（NHANES）中选择了 NAFLD 患者。主要结局为动脉僵硬度（以估计脉搏波速度 ePWV 表示）、全因死亡率和心血管死亡率。采用多因素 Cox 回归模型、限制性立方样条、敏感性分析和亚组分析来探讨胰岛素抵抗指标与死亡率和动脉僵硬度之间的相关性。此外，还使用受试者工作特征曲线比较 eGDR 与甘油三酯-葡萄糖（TyG）指数和胰岛素抵抗的稳态模型评估（HOMA-IR）对全因和心血管死亡率的预测价值。

结果

本研究共纳入 4861 名参与者进行分析。在多变量加权 Cox 回归模型中调整混杂因素后，eGDR 与全因死亡率（Q4 与 Q1，HR=0.65（0.48-0.89，P=0.01）和心血管死亡率（Q4 与 Q1，HR=0.35（0.19-0.65，P<0.001）呈负相关。与 TyG 指数和 HOMA-IR 相比，eGDR 在全因死亡率（0.588 比 0.550 比 0.513，P<0.001）和心血管死亡率（0.625 比 0.553 比 0.537，P<0.001）方面具有更好的预测价值。此外，我们发现 eGDR 与动脉僵硬度呈显著负相关（β=-0.13（-0.14-0.11，P<0.001）。然而，TyG 指数和 HOMA-IR 与动脉僵硬度无显著相关性。