2型糖尿病患者甘油三酯-葡萄糖指数及其与肥胖指标的组合和下肢外周动脉疾病之间的关联：一项横断面研究

The Association Between Triglyceride-Glucose Index and Its Combination with Obesity Indicators and Lower Extremity Peripheral Artery Disease in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study.

作者信息

Miao Ying, Wang Yu, Wang Yi, Yan Pijun, Chen Zhuang, Wan Qin

机构信息

Department of Endocrinology and Metabolism, Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China.

Southwest Medical University, Luzhou, People's Republic of China.

出版信息

Diabetes Metab Syndr Obes. 2024 Jun 27;17:2607-2617. doi: 10.2147/DMSO.S469692. eCollection 2024.

DOI:10.2147/DMSO.S469692

PMID:38953012

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11216433/

Abstract

BACKGROUND

Lower extremity peripheral artery disease (LEAD) is a significant chronic complication of type 2 diabetes mellitus (T2DM) that significantly contributes to disability and mortality. The subtle presentation of LEAD symptoms often leads to underrecognition and misdiagnosis. Therefore, identifying simple and effective evaluation indicators is essential for the early detection and management of LEAD. Insulin resistance is closely associated with diabetes and its complications. However, the specific relationship between insulin resistance-measured by the triglyceride-glucose (TyG) index-and obesity indicators in relation to LEAD remains unclear.

OBJECTIVE

This study aims to investigate the association between the TyG index and its combination with obesity indicators in participants with T2DM and LEAD.

METHODS

We performed a univariate analysis on 3176 T2DM patients to identify risk factors for LEAD. Patients were then divided into quartiles based on the TyG index combined with various obesity indicators. The chi-square test was used to compare the prevalence of LEAD across these groups. Logistic regression analysis was conducted to examine the association between the TyG index, in combination with different obesity indicators, and the occurrence of LEAD. Finally, we assessed the predictive ability of the TyG index combined with obesity indicators for LEAD by comparing the area under the ROC curve (AUC).

RESULTS

The study included 3176 T2DM patients (1691 males and 1485 females) with a mean age of 56.16±10.60 years. Among them, 106 individuals had LEAD. The prevalence of LEAD varied significantly across quartiles of the TyG index, TyG-WC, and TyG-WHR (Q4 > Q3 > Q2 > Q1; P < 0.05). Multiple logistic regression analysis showed that the TyG index, TyG-WC, and TyG-WHR were positively associated with the risk of LEAD in T2DM patients. ROC curve analysis identified the best cutoff values for predicting LEAD: 9.8059 for the TyG index (sensitivity: 49.1%, specificity: 67.9%, AUC: 0.583), 808.8397 for TyG-WC (sensitivity: 70.8%, specificity: 47.8%, AUC: 0.603), and 8.8543 for TyG-WHR (sensitivity: 75.5%, specificity: 44.6%, AUC: 0.607).

CONCLUSION

In T2DM patients, the TyG index, TyG-WHR, and TyG-WC are positively associated with the occurrence of LEAD. TyG-WHR and TyG-WC exhibit a stronger correlation with LEAD compared to the TyG index alone, indicating their superior diagnostic value.

摘要

背景

下肢外周动脉疾病（LEAD）是2型糖尿病（T2DM）的一种重要慢性并发症，对残疾和死亡率有显著影响。LEAD症状表现隐匿，常导致识别不足和误诊。因此，确定简单有效的评估指标对于LEAD的早期检测和管理至关重要。胰岛素抵抗与糖尿病及其并发症密切相关。然而，通过甘油三酯-葡萄糖（TyG）指数测量的胰岛素抵抗与肥胖指标在LEAD方面的具体关系仍不清楚。

目的

本研究旨在探讨T2DM合并LEAD患者中TyG指数及其与肥胖指标的联合情况之间的关联。

方法

我们对3176例T2DM患者进行单因素分析以确定LEAD的危险因素。然后根据TyG指数与各种肥胖指标的组合将患者分为四分位数。采用卡方检验比较这些组中LEAD的患病率。进行逻辑回归分析以检验TyG指数与不同肥胖指标联合时与LEAD发生之间的关联。最后，通过比较ROC曲线下面积（AUC）评估TyG指数与肥胖指标联合对LEAD的预测能力。

结果

该研究纳入了3176例T2DM患者（男性1691例，女性1485例），平均年龄为56.16±10.60岁。其中，106例患有LEAD。LEAD的患病率在TyG指数、TyG-WC和TyG-WHR的四分位数之间有显著差异（Q4>Q3>Q2>Q1；P<0.05）。多因素逻辑回归分析表明，TyG指数、TyG-WC和TyG-WHR与T2DM患者发生LEAD的风险呈正相关。ROC曲线分析确定了预测LEAD的最佳截断值：TyG指数为9.8059（敏感性：49.1%，特异性：67.9%，AUC：0.583），TyG-WC为808.8397（敏感性：70.8%，特异性：47.8%，AUC：0.60），TyG-WHR为8.8543（敏感性：75.5%，特异性：44.6%，AUC：0.607）。