Ma Zhuang, Wu Lanlan, Huang Zheng
Department of Cardiology, The First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiang West Road, Guangzhou, 510520, Guangdong, China.
Cardiovasc Diabetol. 2025 Jun 14;24(1):251. doi: 10.1186/s12933-025-02810-9.
The stress hyperglycemia ratio (SHR), a dynamic biomarker of acute glucose dysregulation, has been established as a predictor of adverse acute outcomes. However, its longitudinal associations with chronic disease development, particularly in middle-aged and older populations, remain insufficiently characterized.
This nationwide prospective cohort study analyzed data from 8942 adults aged ≥ 45 years in the China Health and Retirement Longitudinal Study (CHARLS). We established 14 disease-specific cohorts to the relationship between SHR and new-onset chronic conditions. Multivariable-adjusted Cox proportional hazards models with restricted cubic splines were utilized to estimate hazard ratios (HRs) per standard deviation (SD) increase in SHR, supported by comprehensive sensitivity analyses and subgroup stratifications.
Elevated SHR levels were significantly associated with increased risks of incident hypertension (HR = 1.30, 95% CI: 1.06-1.60; P < 0.001), dyslipidemia (HR = 1.43, 95% CI: 1.17-1.74; P < 0.001), diabetes (HR = 2.30, 95% CI: 1.82-2.91; P < 0.001), and liver disease (HR = 1.65, 95% CI: 1.21-2.26; P = 0.002). Conversely, elevated SHR levels correlated with a lower risk of lung disease (HR = 0.67, 95% CI: 0.50-0.89; P = 0.006). Restricted cubic spline analyses revealed a nonlinear relationship between SHR and diabetes risk (P-nonlinear = 0.02), while linear associations were observed for other outcomes. Subgroup analyses demonstrated consistency across demographic strata (P-interaction > 0.05).
SHR demonstrates disease-specific associations with chronic disease development, indicating its potential value as a predictive marker for clinical risk assessment.
应激性高血糖比率（SHR）是急性血糖失调的动态生物标志物，已被确立为不良急性结局的预测指标。然而，其与慢性疾病发展的纵向关联，尤其是在中老年人群中，仍未得到充分描述。
这项全国性前瞻性队列研究分析了中国健康与养老追踪调查（CHARLS）中8942名年龄≥45岁成年人的数据。我们建立了14个疾病特异性队列，以研究SHR与新发慢性病之间的关系。采用带有受限立方样条的多变量调整Cox比例风险模型，来估计SHR每增加一个标准差（SD）的风险比（HR），并辅以全面的敏感性分析和亚组分层分析。
SHR水平升高与高血压发病风险增加显著相关（HR = 1.30，95%CI：1.06 - 1.60；P < 0.001）、血脂异常（HR = 1.43，95%CI：1.17 - 1.74；P < 0.001）、糖尿病（HR = 2.30，95%CI：1.82 - 2.91；P < 0.001）和肝病（HR = 1.65，95%CI：1.21 - 2.26；P = 0.002）。相反，SHR水平升高与肺病风险降低相关（HR = 0.67，95%CI：0.50 - 0.89；P = 0.006）。受限立方样条分析显示SHR与糖尿病风险之间存在非线性关系（P - 非线性 = 0.02），而其他结局则呈现线性关联。亚组分析表明不同人口统计学分层之间具有一致性（P - 交互作用 > 0.05）。
SHR显示出与慢性疾病发展的疾病特异性关联，表明其作为临床风险评估预测标志物的潜在价值。
