Cabanillas-Lazo Miguel, Quispe-Vicuña Carlos, Pascual-Guevara Milagros, Cruzalegui-Bazán Claudia, Duran-Pecho Arturo, Paz-Ibarra José, Velásquez-Rimachi Victor
Grupo de Investigación Neurociencias, Metabolismo, Efectividad Clínica y Sanitaria (NEMECS), Universidad Científica del Sur, Lima, Perú.
Sociedad Científica de San Fernando, Lima, Perú.
PLoS One. 2025 Jun 25;20(6):e0326179. doi: 10.1371/journal.pone.0326179. eCollection 2025.
Insulin resistance (IR) is a common metabolic disorder associated with obesity, type 2 diabetes, and cardiovascular diseases. There is a need for simpler and more cost-effective indices to diagnose IR in pediatric populations. While the hyperinsulinemic-euglycemic clamp is the gold standard for diagnosing IR, it is costly and complex. Consequently, simpler indices like the triglyceride-to-glucose (TyG) and triglyceride/high-density lipoprotein (Tg/HDL) indices have been explored as alternative diagnostic tools for IR.
This systematic review adhered to PRISMA-DTA guidelines. Analytical studies evaluating the diagnostic accuracy of TyG and Tg/HDL indices for IR in children and adolescents were included. Eligibility criteria required studies to report sensitivity, specificity, or area under the curve (AUC) values compared against reference standards for IR. Excluded studies were those without reported diagnostic accuracy measures. Data were extracted from PubMed, Scopus, Web of Science, Embase, and SciELO Citation Index up to April 2024. Due to high heterogeneity, a narrative synthesis was performed.
Twenty-one studies involving 28,768 participants were included. The TyG index showed sensitivities ranging from 60-92% and specificities of 54-100%, with AUCs between 0.610 and 0.960. For the Tg/HDL index, sensitivities varied from 14.8-85.7%, specificities from 60.9-97.6%, and AUCs from 0.687 to 0.809. These results suggest that the TyG index generally demonstrates higher diagnostic precision than the Tg/HDL index, but both exhibit moderate accuracy with considerable heterogeneity.
The TyG and Tg/HDL indices are promising tools for diagnosing IR in children and adolescents, but further studies with rigorous methodology are needed. Future research should focus on standardizing cut-off points and exploring their predictive value in diverse populations.
胰岛素抵抗（IR）是一种常见的代谢紊乱，与肥胖、2型糖尿病和心血管疾病相关。需要更简单且更具成本效益的指标来诊断儿科人群的IR。虽然高胰岛素正常血糖钳夹技术是诊断IR的金标准，但它成本高昂且操作复杂。因此，诸如甘油三酯与葡萄糖比值（TyG）和甘油三酯/高密度脂蛋白比值（Tg/HDL）等更简单的指标已被探索作为IR的替代诊断工具。
本系统评价遵循PRISMA - DTA指南。纳入评估TyG和Tg/HDL指标对儿童和青少年IR诊断准确性的分析性研究。纳入标准要求研究报告与IR参考标准相比的敏感性、特异性或曲线下面积（AUC）值。排除未报告诊断准确性测量值的研究。截至2024年4月，从PubMed、Scopus、科学引文索引、Embase和SciELO引文索引中提取数据。由于异质性高，进行了叙述性综合分析。
纳入了21项研究，涉及28,768名参与者。TyG指数的敏感性范围为60 - 92%，特异性为54 - 100%，AUC在0.610至0.960之间。对于Tg/HDL指数，敏感性在14.8 - 85.7%之间，特异性在60.9 - 97.6%之间，AUC在0.687至0.809之间。这些结果表明，TyG指数总体上比Tg/HDL指数具有更高的诊断精度，但两者的准确性均为中等，且存在相当大的异质性。
TyG和Tg/HDL指数是诊断儿童和青少年IR的有前景的工具，但需要采用更严谨方法的进一步研究。未来的研究应专注于标准化切点，并探索它们在不同人群中的预测价值。
