Qiao Zhentao, Zhuang Yuansong, Wang Zhiwei
Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Lipids Health Dis. 2024 Dec 18;23(1):403. doi: 10.1186/s12944-024-02394-5.
This study aimed to investigate the associations between noninsulin-dependent insulin resistance indices (NI-IRIs), including the triglyceride-glucose (TyG) index, TyG-BMI, triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C), and metabolic score for insulin resistance (METS-IR), as well as the occurrence of restenosis in patients with lower extremity atherosclerotic occlusive disease after drug-coated balloon (DCB) treatment.
The primary endpoint was restenosis within one year after the procedure, which was defined as ≥ 50% stenosis of the treated artery segment. The association between NI-IRIs and restenosis was assessed via multivariable logistic regression analysis. Restricted cubic spline (RCS) analysis was performed to quantify nonlinearity. The consistency of these associations was confirmed through subgroup and interaction analyses. Additionally, the additional predictive value of NI-IRIs beyond established risk factors for restenosis was evaluated via receiver operating characteristic (ROC) curves, the net reclassification improvement (NRI), and integrated discrimination improvement (IDI) indices.
Except for the TyG index, the other three NI-IRIs demonstrated nonlinear relationships with the probability of postoperative restenosis. Specifically, TG/HDL-C (inflection point: 1.48, P for nonlinearity: 0.003) exhibited a saturating effect, whereas METS-IR (inflection point: 49.30, P for nonlinearity: 0.017) and TyG-BMI (inflection point: 221.53, P for nonlinearity: 0.039) showed threshold effects. Subgroup analysis revealed that the interactions among the subgroups were not statistically significant. Furthermore, among the four NI-IRIs, the addition of the TG/HDL-C index significantly enhanced the predictive power of the base model for restenosis in ASO patients following DCB angioplasty (AUC values: 0.726 vs. 0.760, P = 0.042). The P values for the NRI and IDI were 0.001 and 0.002, respectively.
TG/HDL-C showed a saturating effect on restenosis within one year after DCB treatment in ASO patients, and METS-IR and TyG-BMI showed threshold effects. The addition of the TG/HDL-C index significantly improved the predictive ability of the base model for restenosis in ASO patients who underwent DCB angioplasty.
本研究旨在探讨非胰岛素依赖型胰岛素抵抗指数（NI-IRIs），包括甘油三酯-葡萄糖（TyG）指数、TyG-BMI、甘油三酯与高密度脂蛋白胆固醇比值（TG/HDL-C）以及胰岛素抵抗代谢评分（METS-IR）与药物涂层球囊（DCB）治疗后下肢动脉粥样硬化闭塞症患者再狭窄发生情况之间的关联。
主要终点为术后一年内的再狭窄，定义为治疗动脉段狭窄≥50%。通过多变量逻辑回归分析评估NI-IRIs与再狭窄之间的关联。进行受限立方样条（RCS）分析以量化非线性。通过亚组分析和交互作用分析确认这些关联的一致性。此外，通过受试者工作特征（ROC）曲线、净重新分类改善（NRI）和综合判别改善（IDI）指数评估NI-IRIs在既定再狭窄危险因素之外的额外预测价值。
除TyG指数外，其他三个NI-IRIs与术后再狭窄概率呈非线性关系。具体而言，TG/HDL-C（拐点：1.48，非线性P值：0.003）呈现饱和效应，而METS-IR（拐点：49.30，非线性P值：0.017）和TyG-BMI（拐点：221.53，非线性P值：0.039）呈现阈值效应。亚组分析显示亚组间的交互作用无统计学意义。此外，在四个NI-IRIs中，添加TG/HDL-C指数显著增强了基础模型对DCB血管成形术后ASO患者再狭窄的预测能力（AUC值：0.726对0.760，P = 0.042）。NRI和IDI的P值分别为0.001和0.002。
TG/HDL-C对ASO患者DCB治疗后一年内的再狭窄呈现饱和效应，METS-IR和TyG-BMI呈现阈值效应。添加TG/HDL-C指数显著提高了基础模型对接受DCB血管成形术的ASO患者再狭窄的预测能力。
