Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, 100 Haining Road, Hongkou District, Shanghai, 200080, China.
Lipids Health Dis. 2024 Aug 17;23(1):253. doi: 10.1186/s12944-024-02249-z.
The triglyceride glucose (TyG) index is a cutting-edge and highly effective marker of insulin resistance, a crucial factor in the development and exacerbation of diabetic kidney disease (DKD). To date, there has been limited research on how the triglyceride-glucose (TyG) index affects the outlook for patients suffering from DKD.
In this multicenter retrospective cohort study, the analysis recruited 2,203 DKD patients from the National Health and Nutrition Examination Survey (NHANES) dataset, which covers the US from 2001 to 2018. The research applied a Cox proportional hazards model with multiple variables to investigate the association of the TyG index with mortality outcomes. Restricted cubic splines (RCS) and methods for analyzing threshold effects were employed to identify possible non-linear relationships.
Over nearly 19 years of follow-up, this study captured data on 753 all-cause and 231 cardiovascular disease-specific fatalities. Sophisticated statistical methods, including RCS and smoothing curve adjustments via penalized splines, helped identify distinctive patterns: The baseline TyG index was observed to have a U-shaped pattern related to overall mortality and an L-shape with cardiovascular diseases(CVD) mortality among individuals with DKD. Notably, TyG index below 9.15 for overall mortality and 9.27 for CVD mortality were linked to reduced death rates (HR = 0.65, 95% CI = 0.52-0.82 for all-cause; HR = 0.58, 95% CI = 0.43-0.83 for CVD). On the other hand, TyG index exceeding these benchmarks (greater than 9.15 for all-cause and 9.27 for CVD) correlated with increased all-cause mortality risks (HR = 1.21, 95% CI = 1.02-1.43) and showed a non-significant change in CVD mortality risks (HR = 1.07, 95% CI = 0.83-1.38).
This study emphasizes the non-linear linkage involving the TyG index and death rates due to CVD and other factors in patients with DKD, demonstrating its effectiveness in estimating potential adverse events within this demographic.
三酰甘油葡萄糖（TyG）指数是一种新颖且高效的胰岛素抵抗标志物，而胰岛素抵抗是糖尿病肾病（DKD）发生和恶化的关键因素。迄今为止，关于三酰甘油葡萄糖（TyG）指数如何影响 DKD 患者预后的研究还很有限。
本多中心回顾性队列研究分析了来自美国国家健康和营养检查调查（NHANES）数据集的 2203 例 DKD 患者，该数据集涵盖了 2001 年至 2018 年期间美国的情况。研究采用了带有多变量的 Cox 比例风险模型来研究 TyG 指数与死亡率结局之间的关联。采用受限立方样条（RCS）和分析阈值效应的方法来确定可能存在的非线性关系。
在近 19 年的随访期间，该研究共记录了 753 例全因和 231 例心血管疾病特异性死亡。复杂的统计方法，包括 RCS 和通过惩罚样条进行平滑曲线调整，有助于确定独特的模式：观察到基线 TyG 指数与 DKD 患者的总体死亡率呈 U 型相关，与心血管疾病（CVD）死亡率呈 L 型相关。值得注意的是，TyG 指数低于全因死亡率的 9.15 和 CVD 死亡率的 9.27 与死亡率降低相关（HR=0.65，95%CI=0.52-0.82；HR=0.58，95%CI=0.43-0.83）。另一方面，超过这些临界值（全因死亡率大于 9.15，CVD 死亡率大于 9.27）的 TyG 指数与全因死亡率风险增加相关（HR=1.21，95%CI=1.02-1.43），而 CVD 死亡率风险无显著变化（HR=1.07，95%CI=0.83-1.38）。
本研究强调了 DKD 患者的 TyG 指数与 CVD 和其他因素导致的死亡率之间存在非线性关系，表明其在估计该人群潜在不良事件方面具有有效性。
