心血管-肾脏-代谢综合征0至3期个体中C反应蛋白-甘油三酯-葡萄糖指数不同维度与未来心血管疾病风险的关联：一项全国性队列研究

Association between different dimensions of the C-reactive protein-triglyceride-glucose index and future cardiovascular disease risk in individuals with cardiovascular-kidney-metabolic syndrome stages 0-3: a nationwide cohort study.

作者信息

Chen Jintao, Yan Liying, He Lei, Wang Weixue

机构信息

Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.

Department of Gastroenterology, The People's Hospital of Yongcheng City, Shangqiu, 476600, China.

出版信息

Diabetol Metab Syndr. 2025 Jul 29;17(1):299. doi: 10.1186/s13098-025-01882-7.

DOI:10.1186/s13098-025-01882-7

PMID:40731296

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12306132/

Abstract

BACKGROUND

Cardiovascular-kidney-metabolic (CKM) syndrome highlights the complex interplay between metabolic disturbances, kidney disease, and cardiovascular conditions. In this process, inflammation and insulin resistance play pivotal roles. The C-reactive protein-triglyceride-glucose index (CTI), a novel biomarker of insulin resistance and inflammation, remains unestablished for predicting cardiovascular disease (CVD) risk in CKM syndrome stages 0-3.

METHODS

This study analyzed data from the China Health and Retirement Longitudinal Study. The outcome measure was self-reported CVD. The exposure measure, CTI, was calculated as: 0.412*Ln(C-reactive protein [mg/L]) + Ln[fasting triglycerides (mg/dL) * fasting glucose (mg/dL)/2]. Cumulative CTI was calculated as: (CTI 2012 + CTI 2015)/2 *Time (2015-2012). K-means clustering was used to categorize CTI fluctuations into four distinct clusters. Cox proportional hazards models were employed to examine the relationship between CTI and new-onset CVD risk in individuals across different CKM syndrome stages. The form of this relationship was further analyzed using restricted cubic splines. Additionally, the predictive ability was assessed using the receiver operating characteristic curve.

RESULTS

This study included 5111 individuals with CKM syndrome stages 0-3, with a mean age of 61.78 ± 8.68 years, of which 45.7%(2337) were male. During the follow-up period, 555 new cases of CVD were observed (10.9%). Our findings demonstrated a significant positive linear relationship between CTI and the risk of CVD in individuals with CKM syndrome stages 0-3. In model 3, each 1.0-SD increase in cumulative CTI was associated with a 21% increase in CVD risk (adjusted hazard ratio, aHR = 1.21 [95% CI: 1.10-1.33]). Similarly, each 1.0-SD increase in baseline CTI was associated with an 18% increase in CVD risk (aHR = 1.18 [95% CI: 1.07-1.30]). Additionally, Receiver operating characteristic analysis revealed that cumulative CTI had a better predictive performance for CVD risk compared to the cumulative TyG index (AUC: 0.596 vs 0.560, DeLong test p < 0.05).

CONCLUSIONS

Higher CTI levels in individuals with CKM syndrome stages 0-3 are significantly associated with increased CVD risk. Longitudinal monitoring of CTI changes over time can help early identification of high CVD risk in this population, and its predictive value is significantly superior to that of the TyG index.

摘要

背景

心血管-肾脏-代谢（CKM）综合征突出了代谢紊乱、肾脏疾病和心血管疾病之间复杂的相互作用。在此过程中，炎症和胰岛素抵抗起着关键作用。C反应蛋白-甘油三酯-葡萄糖指数（CTI）作为一种胰岛素抵抗和炎症的新型生物标志物，在预测CKM综合征0-3期的心血管疾病（CVD）风险方面尚未得到确立。

方法

本研究分析了中国健康与养老追踪调查的数据。结局指标为自我报告的心血管疾病。暴露指标CTI的计算方法为：0.412×Ln（C反应蛋白[mg/L]）+Ln[空腹甘油三酯（mg/dL）×空腹血糖（mg/dL）/2]。累积CTI的计算方法为：（2012年CTI+2015年CTI）/2×时间（2015 - 2012年）。采用K均值聚类将CTI波动分为四个不同的类别。使用Cox比例风险模型检验不同CKM综合征阶段个体的CTI与新发心血管疾病风险之间的关系。使用受限立方样条进一步分析这种关系的形式。此外，使用受试者工作特征曲线评估预测能力。

结果

本研究纳入了5111例CKM综合征0-3期患者，平均年龄为61.78±8.68岁，其中45.7%（2337例）为男性。在随访期间，观察到555例新发心血管疾病病例（10.9%）。我们的研究结果表明，CKM综合征0-3期患者的CTI与心血管疾病风险之间存在显著的正线性关系。在模型3中，累积CTI每增加1.0标准差，心血管疾病风险增加21%（调整后风险比，aHR = 1.21[95%CI：1.10 - 1.33]）。同样，基线CTI每增加1.0标准差，心血管疾病风险增加18%（aHR = 1.18[95%CI：1.07 - 1.30]）。此外，受试者工作特征分析显示，与累积TyG指数相比，累积CTI对心血管疾病风险的预测性能更好（AUC：0.596对0.560，DeLong检验p<0.05）。