甘油三酯-葡萄糖指数作为预测中国冠状动脉旁路移植术后长期主要不良心血管事件的胰岛素抵抗的优越标志物。
Triglyceride-glucose index as a superior marker of insulin resistance for predicting long-term major adverse cardiovascular events following coronary artery bypass grafting in China.
作者信息
Sun Xiangfei, Wu Zhenguo, Guo Dachuan, Chen Sha, Song Chunfei, Ran Xiangzhen, Liu Li, Zhang Yerui, Liu Xiaoyu, Cao Guangqing, Yang Jianmin
机构信息
Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi Road, Jinan, 250021, Shandong, China.
Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, China.
出版信息
Sci Rep. 2025 Feb 22;15(1):6450. doi: 10.1038/s41598-025-87967-9.
Insulin resistance (IR) has emerged as a risk factor for coronary artery disease (CAD), but there are currently insufficient data on the association of non-insulin-based IR indexes [triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, triglyceride and glucose (TyG) index, and metabolic score for IR (METS-IR)] with the postoperative prognosis in patients undergoing coronary artery bypass grafting (CABG). Therefore, the present study aimed to examine the predictive power of the above non-insulin-based IR indexes for postoperative prognosis of CABG patients, and to further compare the predictive power of the three indexes. This study included 1472 consecutive CABG patients from June 2014 to January 2019. These patients were divided into two groups based on major adverse cardiovascular events (MACE): without MACE (n = 1136) and with MACE (n = 336). Formulas were used to calculate TyG index, TG/HDL-C, and METS-IR. The Cox regression was done. The study examined how TyG index, TG/HDL-C, and METS-IR improved model performance. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to evaluate this. The evaluation of model goodness-of-fit was conducted by employing the Akaike information criterion (AIC), Bayesian information criterion (BIC), and χ likelihood ratio test. During follow-up, 336 patients experienced the MACE. The associations of TyG index, TG/HDL-C, and METS-IR with MACE were significant. Patients with higher TyG index were at higher risk of MACE (Kaplan-Meier analysis: log-rank P < 0.001; Cox regression: HR = 2.077; 95% CI 1.549-2.784, P < 0.001). The TyG index had the highest area under the curve (AUC) value of 0.593 (95% confidence interval [CI]: 0.557-0.629). The addition of the TyG index yielded a significant improvement in prognostic prediction and model fit [continuous NRI (95% CI): 0.274 (0.1533-0.395), P < 0.001; IDI (95% CI): 0.01(0.0042-0.0159), P < 0.001; AIC: 4662.01; BIC: 4738.35; likelihood ratio test: P < 0.001). The study highlights the prognostic significance of the TyG index, TG/HDL-C, and METS-IR in individuals with CABG. Among these markers, the TyG index had the most robust capacity for predicting MACE. It resulted to be a valuable marker for risk classification and long-term outcome prediction.
胰岛素抵抗（IR）已成为冠状动脉疾病（CAD）的一个危险因素，但目前关于非胰岛素基IR指标[甘油三酯与高密度脂蛋白胆固醇（TG/HDL-C）比值、甘油三酯与葡萄糖（TyG）指数以及IR代谢评分（METS-IR）]与冠状动脉旁路移植术（CABG）患者术后预后之间关联的数据不足。因此，本研究旨在检验上述非胰岛素基IR指标对CABG患者术后预后的预测能力，并进一步比较这三个指标的预测能力。本研究纳入了2014年6月至2019年1月期间连续的1472例CABG患者。这些患者根据主要不良心血管事件（MACE）分为两组：无MACE组（n = 1136）和有MACE组（n = 336）。使用公式计算TyG指数、TG/HDL-C和METS-IR。进行了Cox回归分析。该研究考察了TyG指数、TG/HDL-C和METS-IR如何改善模型性能。使用净重新分类改善（NRI）和综合判别改善（IDI）来评估这一点。通过采用赤池信息准则（AIC）、贝叶斯信息准则（BIC）和χ似然比检验对模型拟合优度进行评估。在随访期间，336例患者发生了MACE。TyG指数、TG/HDL-C和METS-IR与MACE的关联具有显著性。TyG指数较高的患者发生MACE的风险更高（Kaplan-Meier分析：对数秩P < 0.001；Cox回归：HR = 2.077；95%CI 1.549 - 2.784，P < 0.001）。TyG指数的曲线下面积（AUC）值最高，为0.593（95%置信区间[CI]：0.557 - 0.629）。加入TyG指数后，预后预测和模型拟合有显著改善[连续NRI（95%CI）：0.274（0.1533 - 0.395），P < 0.001；IDI（95%CI）：0.01（0.0042 - 0.0159），P < 0.001；AIC：4662.01；BIC：4738.35；似然比检验：P < 0.001]。该研究强调了TyG指数、TG/HDL-C和METS-IR在CABG患者中的预后意义。在这些标志物中，TyG指数预测MACE的能力最强。它是一个用于风险分类和长期结局预测的有价值的标志物。
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