Department of Haematology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, China.
Lipids Health Dis. 2024 Sep 7;23(1):287. doi: 10.1186/s12944-024-02275-x.
Insulin resistance (IR) is prevalent in individuals undergoing peritoneal dialysis (PD) and is related to increased susceptibility to coronary artery disease and initial peritonitis. In recent investigations, correlations have been found between indices of IR and the incidence of all-cause mortality in various populations. However, such correlations have not been detected among individuals undergoing PD. Hence, the present study's aim was to explore the connections between IR indices and the incidence of all-cause mortality in PD patients.
Peritoneal dialysis patients (n = 1736) were recruited from multiple PD centres between January 2010 and December 2021. Cox proportional hazards and restricted cubic spline regression models were used to evaluate the connections between the triglyceride-glucose (TyG) index, triglyceride-glucose/body mass index (TyG-BMI), and triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio and the occurrence of all-cause mortality. All three IR indices were integrated into the same model to assess the predictive stability. Furthermore, a forest plot was employed to display the findings of the subgroup analysis of PD patients.
Overall, 378 mortality events were recorded during a median follow-up time of 2098 days. Among PD patients, a higher TyG index, TyG-BMI, and TG/HDL-C ratio were identified as independent risk factors for all-cause mortality according to Cox proportional hazards analyses (hazard ratio (HR) 1.588, 95% confidence interval (CI) 1.261-2.000; HR 1.428, 95% CI 1.067-1.910; HR 1.431, 95% CI 1.105-1.853, respectively). In a model integrating the three IR indices, the TyG index showed the highest predictive stability. According to the forest plot for the TyG index, no significant interactions were observed among the subgroups.
Significant associations were found between the TyG index, TyG-BMI, and TG/HDL-C ratio and the incidence of all-cause mortality among PD patients. The TyG index may be the most stable of the three surrogate IR markers. Finally, a correlation was identified between IR and the risk of all-cause mortality in patients undergoing PD.
胰岛素抵抗（IR）在接受腹膜透析（PD）的患者中较为常见，与冠状动脉疾病和初始腹膜炎的易感性增加有关。在最近的研究中，已经发现各种人群的 IR 指数与全因死亡率的发生率之间存在相关性。然而，在接受 PD 的患者中并未发现这种相关性。因此，本研究旨在探讨 IR 指数与 PD 患者全因死亡率发生率之间的关系。
从 2010 年 1 月至 2021 年 12 月，从多个 PD 中心招募了 1736 名腹膜透析患者。使用 Cox 比例风险和限制性立方样条回归模型来评估甘油三酯-葡萄糖（TyG）指数、甘油三酯-葡萄糖/体重指数（TyG-BMI）和甘油三酯/高密度脂蛋白胆固醇（TG/HDL-C）比值与全因死亡率发生之间的关系。将所有三个 IR 指数整合到同一个模型中，以评估预测的稳定性。此外，还使用森林图显示了 PD 患者亚组分析的结果。
在中位随访时间为 2098 天期间，总体上记录了 378 例死亡事件。根据 Cox 比例风险分析，PD 患者中较高的 TyG 指数、TyG-BMI 和 TG/HDL-C 比值被确定为全因死亡率的独立危险因素（风险比（HR）1.588，95%置信区间（CI）1.261-2.000；HR 1.428，95%CI 1.067-1.910；HR 1.431，95%CI 1.105-1.853）。在整合三个 IR 指数的模型中，TyG 指数显示出最高的预测稳定性。根据 TyG 指数的森林图，各亚组之间未观察到显著的交互作用。
在 PD 患者中，TyG 指数、TyG-BMI 和 TG/HDL-C 比值与全因死亡率的发生率之间存在显著关联。TyG 指数可能是这三个替代 IR 标志物中最稳定的一个。最后，发现 IR 与 PD 患者全因死亡率的风险之间存在相关性。
