动脉瘤性蛛网膜下腔出血患者甘油三酯-葡萄糖指数与功能预后的关系：一项回顾性队列研究
The relationship between the triglyceride-glucose index and functional outcomes in patients with aneurysmal subarachnoid hemorrhage: a retrospective cohort study.
作者信息
Hou Yuyang, Guo Xinyi, Yang Hongkuan, Li Hua, Chen Rudong, Min Xiaoli, Yu Jiasheng
机构信息
Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei, People's Republic of China.
Department of Outpatient, Wuhan Seventh Rehabilitation Center for Retired Officers, Hubei Military Region, Wuhan, 430021, Hubei, People's Republic of China.
出版信息
Eur J Med Res. 2025 May 9;30(1):375. doi: 10.1186/s40001-025-02629-w.
BACKGROUND
Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening disease with high morbidity and mortality. The triglyceride-glucose (TyG) index, a marker of insulin resistance (IR), has been linked to adverse outcomes in cerebrovascular conditions; however, its influence on functional prognosis in aSAH remains unclear. This study aimed to elucidate the relationship between the TyG index and functional outcomes in aSAH patients.
METHODS
A retrospective cohort study included consecutive aSAH patients. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 3 months and categorized as favorable (mRS 0-2) or unfavorable (mRS 3-6). Univariate and multivariate logistic regression analyzed the association between the TyG index and functional outcomes. Propensity score matching (PSM) was used to mitigate confounding. Non-linear relationships were explored with restricted cubic splines (RCS), and subgroup analyses were performed. A nomogram integrating the TyG index and traditional prognostic scales was developed, and model predictive performance was compared using the area under the curve (AUC) on a test set.
RESULTS
A total of 470 patients (61.7% female) were enrolled, with 154 experiencing unfavorable outcomes. Multivariate logistic regression showed a significant association between the TyG index and adverse outcomes (OR: 1.86, 95% CI 1.12-3.1, P = 0.017). An optimal TyG index cutoff of 8.83 was identified. Patients with TyG index ≥ 8.83 had a higher risk of poor outcomes (48.7% vs. 24.8%; P = 0.015). PSM confirmed these findings. RCS indicated a progressive association between elevated TyG index and increased risk of adverse functional outcome. Subgroup analyses showed consistent relationships. The enhanced model with the TyG index had a higher AUC (0.899) than the traditional model (0.889, DeLong test P = 0.048).
CONCLUSIONS
A high TyG index is significantly associated with an increased risk of unfavorable functional outcomes in patients with aSAH.
背景
动脉瘤性蛛网膜下腔出血（aSAH）是一种危及生命的疾病，发病率和死亡率都很高。甘油三酯-葡萄糖（TyG）指数作为胰岛素抵抗（IR）的一个指标，已被证明与脑血管疾病的不良预后相关；然而，其对aSAH患者功能预后的影响仍不清楚。本研究旨在阐明TyG指数与aSAH患者功能预后之间的关系。
方法
一项回顾性队列研究纳入了连续的aSAH患者。在3个月时使用改良Rankin量表（mRS）评估功能预后，并分为良好（mRS 0-2）或不良（mRS 3-6）。单因素和多因素逻辑回归分析TyG指数与功能预后之间的关联。采用倾向评分匹配（PSM）来减轻混杂因素的影响。使用受限立方样条（RCS）探索非线性关系，并进行亚组分析。开发了一个整合TyG指数和传统预后量表的列线图，并在测试集上使用曲线下面积（AUC）比较模型的预测性能。
结果
共纳入470例患者（61.7%为女性），其中154例预后不良。多因素逻辑回归显示TyG指数与不良预后之间存在显著关联（OR：1.86，95%CI 1.12-3.1，P = 0.017）。确定最佳TyG指数临界值为8.83。TyG指数≥8.83的患者预后不良风险更高（48.7%对24.8%；P = 0.015）。PSM证实了这些发现。RCS表明TyG指数升高与不良功能预后风险增加之间存在渐进关联。亚组分析显示了一致的关系。包含TyG指数的增强模型的AUC（0.899）高于传统模型（0.889，DeLong检验P = 0.048）。
结论
高TyG指数与aSAH患者不良功能预后风险增加显著相关。
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