非糖尿病男性中不同胰岛素抵抗替代指标与勃起功能障碍之间的关联：一项基于大规模人群的研究。
Association between different insulin resistance surrogates and erectile dysfunction in non-diabetic men: a large population-based study.
作者信息
Wu Shenghao, Xia Weiting
机构信息
Reproductive Medicine Center, Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
出版信息
BMC Public Health. 2025 May 27;25(1):1949. doi: 10.1186/s12889-025-23212-2.
BACKGROUND
Although it is widely recognized that insulin resistance (IR) plays a critical role in the development of erectile dysfunction (ED), the specific relationship between IR and ED among non-diabetics has been little studied, and no relevant large-scale studies have been conducted. The purpose of this study is to examine the association between different IR surrogates and the risk of ED in non-diabetic populations.
METHODS
National Health and Nutrition Examination Survey (NHANES) 2001-2004 data were used for this cross-sectional analysis. Weighted multivariable logistic regression and restricted cubic spline curves (RCS) were performed to evaluate the relationship between homeostasis model assessment (HOMA-IR), triglyceride glucose (TyG), TyG with body mass index (TyG-BMI), TyG with waist circumference (TyG-WC) and TyG with waist-to-height ratio (TyG-WHtR), and ED risk. When segmenting effects were detected, recursive algorithms were used to determine potential inflection points. Then log-likelihood ratio test and weighted segmented regression were carried out. In the sensitivity analysis, stratified and interaction analyses were performed.
RESULTS
A total of 1569 (weighted: 76450963) individuals eventually were enrolled in the study. After adjusting for all confounders, the TyG did not correlate with ED (P > 0.05), whereas the other IR surrogates, HOMA-IR, TyG-BMI, TyG-WC, and TyG-WHtR, remained positively correlated with ED [ORs (95% CIs) were 1.02 (0.95, 1.10), 1.01 (1.00, 1.02), 1.00 (1.00, 1.01), 1.17 (0.84, 1.63), respectively; all P < 0.05]. Furthermore, we found the risk of ED was significantly higher when TyG-BMI > 328.94 or TyG-WC > 1128.25 or TyG-WHtR > 6.42 [the ORs (95% CIs) were 1.05 (1.02, 1.08), 1.02 (1.01, 1.03) and 51.30 (4.46, 453.64), respectively]. No interactions were found between these IR surrogates and the stratification variables.
CONCLUSIONS
In the non-diabetic population, ED risk was positively associated with elevated HOMA-IR, TyG-BMI, TyG-WC, and TyG-WHtR.
背景
尽管人们普遍认识到胰岛素抵抗（IR）在勃起功能障碍（ED）的发生发展中起关键作用，但非糖尿病患者中IR与ED之间的具体关系鲜有研究，且尚未进行相关大规模研究。本研究的目的是探讨不同IR替代指标与非糖尿病人群ED风险之间的关联。
方法
本横断面分析使用了2001 - 2004年美国国家健康与营养检查调查（NHANES）的数据。采用加权多变量逻辑回归和受限立方样条曲线（RCS）来评估稳态模型评估（HOMA - IR）、甘油三酯葡萄糖（TyG）、结合体重指数的TyG（TyG - BMI）、结合腰围的TyG（TyG - WC）以及结合腰高比的TyG（TyG - WHtR）与ED风险之间的关系。当检测到分段效应时，使用递归算法确定潜在的拐点。然后进行对数似然比检验和加权分段回归。在敏感性分析中，进行了分层分析和交互分析。
结果
最终共有1569名（加权后：76450963）个体纳入本研究。在调整所有混杂因素后，TyG与ED无相关性（P > 0.05），而其他IR替代指标，即HOMA - IR、TyG - BMI、TyG - WC和TyG - WHtR，与ED仍呈正相关[比值比（95%置信区间）分别为1.02（0.95，1.10）、1.01（1.00，1.02）、1.00（1.00，1.01）、1.17（0.84，1.63）；均P < 0.05]。此外，我们发现当TyG - BMI > 328.94或TyG - WC > 1128.25或TyG - WHtR > 6.42时，ED风险显著更高[比值比（95%置信区间）分别为1.05（1.02，1.08）、1.02（1.01，1.03）和51.30（4.46，453.64）]。在这些IR替代指标与分层变量之间未发现交互作用。
结论
在非糖尿病人群中，ED风险与升高的HOMA - IR、TyG - BMI、TyG - WC和TyG - WHtR呈正相关。
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