Chen Tong, Liu Yu, Wu Shiquan, Long Siyu, Feng Ling, Lu Wenqian, Chen Wenya, Hong Guoai, Zhou Li, Wang Fang, Luo Yuechan, Zou Hequn, Liu Weihua
Department of Nephrology, Chongqing Key Laboratory of Prevention and Treatment of Kidney Disease, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China.
South China Hospital of Shenzhen University, Shenzhen, 518116, People's Republic of China.
Diabetes Metab Syndr Obes. 2024 Aug 19;17:3063-3075. doi: 10.2147/DMSO.S469260. eCollection 2024.
Obesity and insulin resistance (IR) are positively associated with chronic kidney disease (CKD). Previous studies have identified triglyceride-glucose index (TyG) as a valuable surrogate of insulin resistance. Recently, new indicators combining TyG and simple anthropometric indices have emerged, The objective of this study was to assess the diagnostic accuracy of TyG and newly TyG related indicators in detecting CKD and explore which indices were superior in associating with CKD in Chinese population.
Correlation test, logistic regression analysis, and receiver operating characteristic (ROC) analyses were used to evaluate the optimal cut-off and value of TyG, TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), TyG-waist to height ratio (TyG-WHtR) for predicting CKD.
TyG-WHtR, TyG-WC, and TyG-BMI correlated with several risk factors for CKD. After adjusting for confounders, TyG-WHtR and TyG-WC remained significantly associated with CKD, while TyG-BMI did not. The highest quartiles of TyG-WHtR and TyG-WC had 1.95- and 1.91-fold increased risk of CKD than the lowest quartiles (P<0.05). TyG-WHtR had the largest AUC (0.687) for CKD detection, followed by TyG-WC (0.669), TyG (0.652), and TyG-BMI (0.648). A united model that involved TyG-WHtR and other risk variables had higher predictive performance (AUC=0.791) than a single TyG related indicator. However, TyG had the highest OR (2.713, 95% CI, 1.446-5.090) for reduced eGFR in the fully adjusted model. A united model that involved TyG and WHtR separately had stronger predictive ability (AUC: 0.794) than the model that involved TyG-WHtR individually (AUC:0.791).
This study found that TyG-WHtR had a better diagnostic value in the diagnosis of CKD, compared to other TyG related indicators, but none of the TyG related indicators showed a stronger association with CKD than TyG. Further research and more refined algorithms are needed to verify these new indicators.
肥胖和胰岛素抵抗（IR）与慢性肾脏病（CKD）呈正相关。既往研究已将甘油三酯-葡萄糖指数（TyG）确定为胰岛素抵抗的一个有价值替代指标。最近，结合TyG和简单人体测量指标的新指标不断涌现。本研究的目的是评估TyG及新的TyG相关指标在检测CKD方面的诊断准确性，并探讨在中国人群中哪些指标与CKD的关联性更强。
采用相关性检验、逻辑回归分析和受试者工作特征（ROC）分析来评估TyG、TyG-体重指数（TyG-BMI）、TyG-腰围（TyG-WC）、TyG-腰高比（TyG-WHtR）预测CKD的最佳截断值和数值。
TyG-WHtR、TyG-WC和TyG-BMI与CKD的多个危险因素相关。在调整混杂因素后，TyG-WHtR和TyG-WC仍与CKD显著相关，而TyG-BMI则不然。TyG-WHtR和TyG-WC最高四分位数的CKD风险分别比最低四分位数高1.95倍和1.91倍（P<0.05）。TyG-WHtR检测CKD的AUC最大（0.687），其次是TyG-WC（0.669）、TyG（0.652）和TyG-BMI（0.648）。一个包含TyG-WHtR和其他风险变量的联合模型比单个TyG相关指标具有更高的预测性能（AUC=0.791）。然而，在完全调整模型中，TyG对估算肾小球滤过率降低的OR最高（2.713，95%CI，1.446-5.090）。一个分别包含TyG和腰高比的联合模型比单独包含TyG-WHtR的模型具有更强的预测能力（AUC：0.794）（AUC：0.791）。
本研究发现，与其他TyG相关指标相比，TyG-WHtR在CKD诊断中具有更好的诊断价值，但没有一个TyG相关指标与CKD的关联性比TyG更强。需要进一步研究和更精细的算法来验证这些新指标。
