Department of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
Cardiovasc Diabetol. 2024 Jun 1;23(1):188. doi: 10.1186/s12933-024-02287-y.
Insulin resistance (IR) plays a vital role in the pathogenesis of the metabolic dysfunction-associated steatotic liver disease (MASLD). However, it remains unclear whether triglyceride-glucose (TyG) related parameters, which serve as useful biomarkers to assess IR, have prognostic effects on mortality outcomes of MASLD.
Participants in the National Health and Nutrition Examination Survey (NHANES) database from 1999 to 2018 years were included. TyG and its related parameters [TyG-waist circumference (TyG-WC) and TyG-waist to height ratio (TyG-WHtR)] were calculated. Kaplan-Meier curves, Cox regression analysis, and restricted cubic splines (RCS) were conducted to evaluate the association between TyG-related indices with the all-cause and cardiovascular mortality of adults with MASLD. The concordance index (C-index) was used to evaluate the prediction accuracy of TyG-related indices.
A total of 8208 adults (4209 men and 3999 women, median age 49.00 years) with MASLD were included in this study. Multivariate-adjusted Cox regression analysis revealed that high quartile levels of TyG-related indices were significantly associated with the all-cause mortality of participants with MASLD [adjusted hazard ratio (aHR) = 1.25, 95% confidence interval (CI) 1.05-1.50, P = 0.014; aHR for all-cause mortality = 1.28, 95% CI 1.07-1.52, P = 0.006; aHR for all-cause mortality = 1.50, 95% CI 1.25-1.80, P < 0.001; aHR for cardiovascular mortality = 1.81, 95% CI 1.28-2.55, P = 0.001; aHR for cardiovascular mortality = 2.22, 95% CI 1.55-3.17, P < 0.001]. The C-index of TyG-related indices for predicting all-cause mortality was 0.563 for the TyG index, 0.579 for the TyG-WC index, and 0.585 for the TyG-WHtR index, respectively. Regarding cardiovascular mortality, the C-index was 0.561 for the TyG index, 0.607 for the TyG-WC index, and 0.615 for the TyG-WHtR index, respectively. Nonlinear trends were observed between TyG and TyG-WC indices with all-cause mortality of MASLD (P < 0.001 and = 0.012, respectively). A non-linear relationship was observed between the TyG index and cardiovascular mortality of MASLD (P = 0.025). Subgroup analysis suggested that adults aged < 65 years old and those without comorbidities were more sensitive to the mortality prediction of TyG-related indices.
Findings of this study highlight the predictive value of TyG-related indices, especially the TyG-WHtR index, in the mortality outcomes of adults with MASLD. TyG-related indices would be surrogate biomarkers for the clinical management of MASLD.
胰岛素抵抗（IR）在代谢功能相关脂肪性肝病（MASLD）发病机制中起着至关重要的作用。然而，尚不清楚甘油三酯-葡萄糖（TyG）相关参数作为评估 IR 的有用生物标志物，是否对 MASLD 患者的死亡率结局具有预后作用。
纳入了来自 1999 年至 2018 年全国健康与营养调查（NHANES）数据库的参与者。计算了 TyG 及其相关参数[TyG-腰围（TyG-WC）和 TyG-腰围身高比（TyG-WHtR）]。Kaplan-Meier 曲线、Cox 回归分析和限制性立方样条（RCS）用于评估 TyG 相关指数与 MASLD 成人全因和心血管死亡率之间的关联。采用一致性指数（C-index）评估 TyG 相关指数的预测准确性。
本研究共纳入了 8208 名患有 MASLD 的成年人（4209 名男性和 3999 名女性，中位年龄 49.00 岁）。多变量调整后的 Cox 回归分析显示，TyG 相关指数的四分位水平与 MASLD 患者的全因死亡率显著相关[调整后的危险比（aHR）=1.25，95%置信区间（CI）1.05-1.50，P=0.014；全因死亡率的 aHR=1.28，95%CI 1.07-1.52，P=0.006；全因死亡率的 aHR=1.50，95%CI 1.25-1.80，P<0.001；心血管死亡率的 aHR=1.81，95%CI 1.28-2.55，P=0.001；心血管死亡率的 aHR=2.22，95%CI 1.55-3.17，P<0.001]。TyG 相关指数预测全因死亡率的 C 指数分别为 TyG 指数 0.563、TyG-WC 指数 0.579 和 TyG-WHtR 指数 0.585。对于心血管死亡率，C 指数分别为 TyG 指数 0.561、TyG-WC 指数 0.607 和 TyG-WHtR 指数 0.615。TyG 与 TyG-WC 指数与 MASLD 全因死亡率之间呈非线性趋势（P<0.001 和=0.012）。TyG 指数与 MASLD 心血管死亡率之间呈非线性关系（P=0.025）。亚组分析表明，年龄<65 岁和无合并症的成年人对 TyG 相关指数的死亡率预测更为敏感。
本研究结果强调了 TyG 相关指数，特别是 TyG-WHtR 指数，在 MASLD 成人死亡率结局中的预测价值。TyG 相关指数可能成为 MASLD 临床管理的替代生物标志物。
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