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在美国一般人群中,甘油三酯-葡萄糖指数及其与全身炎症指标的组合与全因和心血管死亡率的关系:NHANES 1999-2018。

The association between triglyceride-glucose index and its combination with systemic inflammation indicators and all-cause and cardiovascular mortality in the general US population: NHANES 1999-2018.

机构信息

Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning Province, People's Republic of China.

The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, People's Republic of China.

出版信息

Lipids Health Dis. 2024 Sep 10;23(1):289. doi: 10.1186/s12944-024-02277-9.


DOI:10.1186/s12944-024-02277-9
PMID:39256829
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11386374/
Abstract

BACKGROUND: The correlation between the triglyceride-glucose (TyG) index and mortality in the general population remains controversial, with inconsistent conclusions emerging from different studies. OBJECTIVE: This study aims to investigate whether there is an association between the TyG index and mortality in the general population in the United States, and to explore whether a new index combining the TyG index with systemic inflammation indicators can better predict all-cause and cardiovascular mortality risks in the general population than using the TyG index alone. METHODS: Calculate the systemic inflammation indicators and TyG index for each participant based on their complete blood count, as well as their triglyceride and glucose levels in a fasting state. TyG-inflammation indices were obtained by multiplying the TyG index with systemic inflammation indicators (TyG-NLR, TyG-MLR, TyG-lgPLR, TyG-lgSII, and TyG-SIRI). Based on the weighted Cox proportional hazards model, assess whether the TyG and TyG-Inflammation indices are associated with mortality risk in the general population. Restricted cubic splines (RCS) are used to clarify the dose-response relationship between the TyG and TyG-Inflammation indices and mortality, and to visualize the results. Time-dependent receiver operating characteristic (ROC) curves are used to evaluate the accuracy of the TyG and TyG-Inflammation indices in predicting adverse outcomes. RESULTS: This study included 17,118 participants. Over a median follow-up period of 125 months, 2595 patients died. The TyG index was not found to be related to mortality after adjusting for potentially confounding factors. However, the TyG-inflammation indices in the highest quartile (Q4), except for TyG-lgPLR, were significantly associated with both all-cause and cardiovascular mortality, compared to those in the lowest quartile (Q1). Among them, TyG-MLR and TyG-lgSII showed the strongest correlations with all-cause mortality and cardiovascular mortality. Specifically, compared to their respective lowest quartiles (Q1), participants in the highest quartile (Q4) of TyG-MLR had a 48% increased risk of all-cause mortality (95% CI: 1.23-1.77, P for trend < 0.0001), while participants in the highest quartile (Q4) of TyG-lgSII had a 92% increased risk of cardiovascular mortality (95% CI: 1.31-2.81, P for trend < 0.001). Time-dependent ROC curve analysis showed that the TyG-MLR had the highest accuracy in predicting long-term mortality outcomes. CONCLUSIONS: The TyG-Inflammation indices constructed based on TyG and systemic inflammation indicators are closely related to mortality in the general population and can better predict the risk of adverse outcomes. However, no association between TyG and mortality in the general population was found.

摘要

背景:甘油三酯-葡萄糖(TyG)指数与普通人群死亡率之间的相关性仍存在争议,不同研究得出的结论不一致。

目的:本研究旨在探讨美国普通人群中 TyG 指数与死亡率之间是否存在关联,并探讨将 TyG 指数与全身炎症指标相结合构建的新指数是否比单独使用 TyG 指数能更好地预测普通人群的全因和心血管死亡率风险。

方法:根据参与者的全血细胞计数以及空腹时的甘油三酯和葡萄糖水平,计算全身炎症指标和 TyG 指数。通过将 TyG 指数与全身炎症指标(TyG-NLR、TyG-MLR、TyG-lgPLR、TyG-lgSII 和 TyG-SIRI)相乘,得到 TyG-炎症指数。基于加权 Cox 比例风险模型,评估 TyG 和 TyG-炎症指数与普通人群死亡率风险之间的关联。使用限制性立方样条(RCS)阐明 TyG 和 TyG-炎症指数与死亡率之间的剂量-反应关系,并可视化结果。使用时间依赖性接收器操作特征(ROC)曲线评估 TyG 和 TyG-炎症指数预测不良结局的准确性。

结果:本研究纳入了 17118 名参与者。在中位随访 125 个月期间,有 2595 名患者死亡。调整潜在混杂因素后,TyG 指数与死亡率无相关性。然而,除了 TyG-lgPLR 之外,TyG-炎症指数最高四分位数(Q4)与全因和心血管死亡率显著相关,与最低四分位数(Q1)相比。其中,TyG-MLR 和 TyG-lgSII 与全因死亡率和心血管死亡率相关性最强。具体而言,与各自的最低四分位数(Q1)相比,TyG-MLR 最高四分位数(Q4)的参与者全因死亡率风险增加 48%(95%CI:1.23-1.77,P<0.0001),而 TyG-lgSII 最高四分位数(Q4)的参与者心血管死亡率风险增加 92%(95%CI:1.31-2.81,P<0.001)。时间依赖性 ROC 曲线分析显示,TyG-MLR 在预测长期死亡率结局方面具有最高的准确性。

结论:基于 TyG 和全身炎症指标构建的 TyG-炎症指数与普通人群的死亡率密切相关,能更好地预测不良结局风险。然而,在普通人群中并未发现 TyG 与死亡率之间存在关联。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11386374/4f92dd4bdb9b/12944_2024_2277_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11386374/68724b88e8a5/12944_2024_2277_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11386374/d595a189d9c9/12944_2024_2277_Fig2_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11386374/7fd13bc88634/12944_2024_2277_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11386374/d8375268c13b/12944_2024_2277_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11386374/4f92dd4bdb9b/12944_2024_2277_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11386374/68724b88e8a5/12944_2024_2277_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11386374/d595a189d9c9/12944_2024_2277_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11386374/fb77223ed031/12944_2024_2277_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11386374/7fd13bc88634/12944_2024_2277_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11386374/d8375268c13b/12944_2024_2277_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7fb/11386374/4f92dd4bdb9b/12944_2024_2277_Fig6_HTML.jpg

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本文引用的文献

[1]
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Front Cardiovasc Med. 2024-6-18

[2]
Elevated AIP is associated with the prevalence of MAFLD in the US adults: evidence from NHANES 2017-2018.

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Cardiovasc Diabetol. 2024-4-24

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BMC Geriatr. 2024-4-22

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Unraveling the clinical significance and prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and delta neutrophil index: An extensive literature review.

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