三酰甘油-葡萄糖指数及其衍生指数与老年男性代谢相关脂肪性肝病的相关性分析
Association between triglyceride glucose index and its related derivative index and metabolic associated fatty liver disease in the elderly men
- 解放军医学杂志 2023年48卷第11期 页码：1344-1352
- 作者机构：
1.解放军总医院第二医学中心门诊部急诊医学科/国家老年疾病临床研究中心，北京 100853
2.解放军总医院第二医学中心消化内科/国家老年疾病临床医学研究中心，北京 100853
- 作者简介：
康娟，医学学士，主要从事慢性肝病方面的临床研究
庄颖洁，E-mail： zhuangyj1201@163.com
- 基金信息：
DOI：10.11855/j.issn.0577-7402.0544.2023.1012
中图分类号：
扫 描 看 全 文
康娟, 刘文徽, 常青, 等. 三酰甘油-葡萄糖指数及其衍生指数与老年男性代谢相关脂肪性肝病的相关性分析[J]. 解放军医学杂志, 2023, 48(11): 1344-1352.
Kang Juan,Liu Wen-Hui,Chang Qing,et al.Association between triglyceride glucose index and its related derivative index and metabolic associated fatty liver disease in the elderly men[J].Medical Journal of Chinese People′s Liberation Army,2023,48(11):1344-1352.
康娟, 刘文徽, 常青, 等. 三酰甘油-葡萄糖指数及其衍生指数与老年男性代谢相关脂肪性肝病的相关性分析[J]. 解放军医学杂志, 2023, 48(11): 1344-1352. DOI： 10.11855/j.issn.0577-7402.0544.2023.1012.
Kang Juan,Liu Wen-Hui,Chang Qing,et al.Association between triglyceride glucose index and its related derivative index and metabolic associated fatty liver disease in the elderly men[J].Medical Journal of Chinese People′s Liberation Army,2023,48(11):1344-1352. DOI： 10.11855/j.issn.0577-7402.0544.2023.1012.
摘要
目的,2,探讨三酰甘油-葡萄糖(TyG)指数及其衍生指数三酰甘油-葡萄糖-体重指数(TyG-BMI)与老年男性人群代谢相关脂肪性肝病(MAFLD)患病风险之间的相关性。,方法,2,选取2021年1－12月于解放军总医院第二医学中心门诊行年度体检的2290例老年男性，分为MAFLD组(,n,=1322)与非MAFLD组(,n,=968)。筛选MAFLD患病的混杂因素，采用多因素logistic回归分析TyG指数及TyG-BMI与MAFLD患病风险的相关性，并绘制受试者工作特征(ROC)曲线探讨其对老年男性MAFLD患病风险的预测价值。,结果,2,2290例体检者年龄(74.3±10.1)岁，体重指数(BMI)为(24.63±2.70) kg/m,2,。MAFLD组BMI、γ-谷氨酰氨基转移酶(γ-GT)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、血肌酐(Scr)、促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT,3,)、吸烟、饮酒率，以及高血压、糖尿病、高尿酸血症、高甘油三酯(TG)血症、低高密度脂蛋白胆固醇(HDL-C)血症、甲状腺结节、胆系结石等的患病率明显高于非MAFLD组(,P,<,0.05)，年龄低于非MAFLD组(,P,=0.003)。调整混杂因素后，多因素logistic回归分析显示，按TyG指数四分位数分组的Q,2,组、Q,3,组、Q,4,组患MAFLD的风险分别是Q,1,组的1.667倍(95%CI 1.257~2.236，,P,<,0.001)、2.004倍(95%CI 1.482~2.710，,P,<,0.001)、5.420倍(95%CI 3.266~8.995，,P,<,0.001)；按TyG-BMI四分位数分组的Q,2,组、Q,3,组、Q,4,组患MAFLD的风险分别是Q,1,组的2.215倍(95%CI 1.549~3.167，,P,<,0.001)、2.809倍(95%CI 1.723~4.580，,P,<,0.001)、2.513倍(95%CI 1.253~5.040，,P,=0.009)。TyG指数及TyG-BMI预测老年男性MAFLD的ROC曲线下面积(AUC)分别为0.717(95%CI 0.696~0.738)、0.840(95%CI 0.823~0.856)，最佳截断值分别为8.63、205.20；在无高脂血症及糖尿病的老年男性中，TyG指数与TyG-BMI预测MAFLD的AUC分别为0.653(95%CI 0.622~0.684)、0.840(95%CI 0.818~0.862)，最佳截断值分别为8.42、202.66。TyG-BMI预测MAFLD的AUC、准确率、特异度、敏感度、阳性预测值、阴性预测值均高于TyG指数。,结论,2,TyG指数及TyG-BMI高水平状态与老年男性MAFLD患病风险升高相关。TyG指数及TyG-BMI对老年男性MAFLD患病均有一定的预测价值，而TyG-BMI较TyG指数的预测价值更优。
Abstract
Objective,2,To explore the association between triglyceride glucose (TyG) index and TyG-body mass index (TyG-BMI) and the prevalence of metabolic associated fatty liver disease (MAFLD) in the elderly men.,Methods,2,Totally 2290 elderly men were selected from January to December in 2021 in the Second Medical Center of Chinese PLA General Hospital, and divided into MAFLD group (,n,=1322) and non-MAFLD group (,n,=968). Multivariate logistic regression was used to analyze the association between TyG index, TyG-BMI and MAFLD. The receiver operating characteristic (ROC) curve was drawn to explore the predictive value of TyG index and TyG-BMI with MAFLD in the elderly men.,Results,2,Two thousand two hundred and ninety elderly men were (74.3±10.1) years old, and an average BMI of (24.63±2.70) kg/m,2,. BMI, γ‑glutamyl transaminase (γ‑GT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine (Scr), thyroid stimulating hormone (TSH), free triiodothyronine (FT,3,), the rate of smoking and drinking, and the prevalence of hypertension, diabetes, hyperuricemia, high triglyceride (TG), low high density lipoprotein cholesterol (HDL-C), hyperuricemia, thyroid nodules and cholelithiasis were all significantly higher in non-MAFLD group than those in MAFLD group (,P,<,0.05), while the age of MAFLD group was lower than that of non-MAFLD group (,P,=0.003). Multivariate logistic regression analysis showed that the risk of MAFLD in patients of TyG quartile groups Q,2, Q,3, Q,4, was 1.667 (95%CI 1.257-2.236,P,<,0.001), 2.004 (95%CI 1.482-2.710,P,<,0.001) and 5.420 (95%CI 3.266-8.995,P,<,0.001) times higher than that of TyG Q,1, respectively. The risk of MAFLD in patients of TyG-BMI Q,2, Q,3, Q,4, was 2.215 (95%CI 1.549-3.167,P,<,0.001), 2.809 (95%CI 1.723-4.580,P,<,0.001) and 2.513 (95%CI 1.253-5.040,P,=0.009) times higher than that of TyG-BMI Q,1, respectively. The ROC curve showed that areas under the curve (AUC) of MAFLD predicted by TyG index and TyG-BMI were 0.717 (95%CI 0.696-0.738) and 0.840 (95%CI 0.823-0.856), and the best cut-off values were 8.63 and 205.20, respectively. Moreover, the ROC curve showed that AUC of MAFLD in the elderly men without hyperlipidemia or diabetes predicted by TyG index and TyG-BMI were 0.653 (95%CI 0.622-0.684) and 0.840 (95%CI 0.818-0.862), and the best cut-off values were 8.42 and 202.66, respectively. In addition, AUC, accuracy, specificity, sensitivity, positive predictive value and negative predictive value predicted by TyG-BMI were higher than those by TyG index.,Conclusions,2,TyG index and TyG-BMI are significantly associated with MAFLD in the elderly men. Both TyG index and TyG-BMI have certain predictive value for the prevalence of MAFLD in the elderly men, and TyG-BMI may be better.
关键词
非酒精性脂肪性肝病三酰甘油葡萄糖体重指数ROC曲线
Keywords
non-alcoholic fatty liver diseasetriacylglycerolglucosebody mass indexreceiver operating characteristic curve
references
Younossi Z, Tacke F, Arrese M, et al. Global perspectives on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis[J]. Hepatology, 2019, 69(6): 2672-2682.
Wu WW, Li XW, Cui LH. The value of changes in diagnostic criteria for fatty liver in stratified management of cardiovascular risk[J]. Med J Chin PLA, 2021, 46(5): 486-491.
吴婉雯, 李晓伟, 崔立红. 脂肪肝诊断标准的变更对心血管疾病风险分层管理的价值分析[J]. 解放军医学杂志, 2021, 46(5): 486-491.
Younossi Z, Anstee QM, Marietti M, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention[J]. Nat Rev Gastroenterol Hepatol, 2018, 15(1): 11-20.
Brar G, Tsukamoto H. Alcoholic and non-alcoholic steatohepatitis: global perspective and emerging science[J]. J Gastroenterol, 2019, 54(3): 218-225.
Shiha G, Korenjak M, Eskridge W, et al. Redefining fatty liver disease: an international patient perspective[J]. Lancet Gastroenterol Hepatol, 2021, 6(1): 73-79.
Du TT, Yuan G, Zhang MX, et al. Clinical usefulness of lipid ratios, visceral adiposity indicators, and the triglycerides and glucose index as risk markers of insulin resistance[J]. Cardiovasc Diabetol, 2014, 13: 146.
Navarro-González D, Sánchez-Íñigo L, Pastrana-Delgado J, et al. Triglyceride-glucose index (TyG index) in comparison with fasting plasma glucose improved diabetes prediction in patients with normal fasting glucose: The Vascular-Metabolic CUN cohort[J]. Prev Med, 2016, 86: 99-105.
Ramdas Nayak VK, Satheesh P, Shenoy MT, et al. Triglyceride glucose (TyG) index: a surrogate biomarker of insulin resistance[J]. J Pak Med Assoc, 2022, 72(5): 986-988.
Chen Y, Wang YT, Qian WJ, et al. Correlation of visceral fat area and sarcopenia in patient with type 2 diabetes[J]. Med J Chin PLA, 2020, 45(6): 651-656.
陈月, 王蕴婷, 钱文杰, 等. 2型糖尿病内脏脂肪面积与肌少症的相关性分析[J]. 解放军医学杂志, 2020, 45(6): 651-656.
Zhou L, Liao MY, Li X, et al. Changes of peroxiredoxin 6 level in patients with polycystic ovary syndrome and the relativity with glucose and lipid metabolism and sex hormone levels[J]. Med J Chin PLA, 2022, 47(3): 243-250.
周玲, 廖明钰, 李行, 等. PRDX6在多囊卵巢综合征患者中的表达变化及其与糖脂代谢、性激素水平的相关性分析[J]. 解放军医学杂志, 2022, 47(3): 243-250.
Vasques AC, Novaes FS, de Oliveira Mda S, et al. TyG index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study[J]. Diabetes Res Clin Pract, 2011, 93(3): e98-e100.
Son DH, Lee HS, Lee YJ, et al. Comparison of triglyceride-glucose index and HOMA-IR for predicting prevalence and incidence of metabolic syndrome[J]. Nutr Metab Cardiovasc Dis, 2022, 32(3): 596-604.
Zhang M, Wang BY, Liu Y, et al. Cumulative increased risk of incident type 2 diabetes mellitus with increasing triglyceride glucose index in normal-weight people: the Rural Chinese Cohort Study[J]. Cardiovasc Diabetol, 2017, 16(1): 30.
Lee DY, Lee ES, Kim JH, et al. Predictive value of triglyceride glucose index for the risk of incident diabetes: a 4-year retrospective longitudinal study[J]. PLoS One, 2016, 11(9): e0163465.
Jian S, Su-Mei N, Xue C, et al. Association and interaction between triglyceride-glucose index and obesity on risk of hypertension in middle-aged and elderly adults[J]. Clin Exp Hypertens, 2017, 39(8): 732-739.
Mao Q, Zhou DL, Li YM, et al. The triglyceride-glucose index predicts coronary artery disease severity and cardiovascular outcomes in patients with non-ST-segment elevation acute coronary syndrome[J]. Dis Markers, 2019, 2019: 6891537.
Lee SB, Ahn CW, Lee BK, et al. Association between triglyceride glucose index and arterial stiffness in Korean adults[J]. Cardiovasc Diabetol, 2018, 17(1): 41.
Lambrinoudaki I, Kazani MV, Armeni E, et al. The TyG index as a marker of subclinical atherosclerosis and arterial stiffness in lean and overweight postmenopausal women[J]. Heart Lung Circ, 2018, 27(6): 716-724.
Li MW, Chi XW, Wang Y, et al. Trends in insulin resistance: insights into mechanisms and therapeutic strategy[J]. Signal Transduct Target Ther, 2022, 7(1): 216.
Er LK, Wu S, Chou HH, et al. Triglyceride glucose-body mass index is a simple and clinically useful surrogate marker for insulin resistance in nondiabetic individuals[J]. PLoS One, 2016, 11(3): e0149731.
Eslam M, Sarin SK, Wong VWS, et al. The Asian Pacific Association for the Study of the Liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease[J]. Hepatol Int, 2020, 14(6): 889-919.
Bureau of Disease Prevention and Control, National Health Commission of People′s Republic of China, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science & Peking Union Medical College, Fuwai Hospital, et al. National guideline for hypertension management in China (2019)[J]. Chin J Cardiol, 2020, 48(1): 10-46.
国家卫生健康委员会疾病预防控制局, 国家心血管病中心, 中国医学科学院阜外医院, 等. 中国高血压健康管理规范(2019)[J]. 中华心血管病杂志, 2020, 48(1): 10-46.
Chinese Diabetes Society.Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition)[J]. Chin J Diabetes Mellitus, 2021, 13(4): 315-409.
中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021, 13(4): 315-409.
Zhao SP. Key points and comments on the 2016 Chinese guideline for the management of dyslipidemia in adults[J]. Chin J Cardiol, 2016, 44(10): 833-853.
赵水平. 《中国成人血脂异常防治指南(2016年修订版)》要点与解读[J]. 中华心血管病杂志, 2016, 44(10): 827-829.
Chinese Society of Endocrinology, Chinese Medical Association. Guideline for the diagnosis and management of hyperuricemia and gout in China (2019)[J]. Chin J Endocrinol Metab, 2020, 36(1): 1-13.
中华医学会内分泌学分会. 中国高尿酸血症与痛风诊疗指南(2019)[J]. 中华内分泌代谢杂志, 2020, 36(1): 1-13.
Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects[J]. Metab Syndr Relat Disord, 2008, 6(4): 299-304.
Alqahtani SA, Schattenberg JM. NAFLD in the Elderly[J]. Clin Interv Aging, 2021, 16: 1633-1649.
Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes[J]. Hepatology, 2016, 64(1): 73-84.
Sanyal AJ, Campbell-Sargent C, Mirshahi F, et al. Nonalcoholic steatohepatitis: association of insulin resistance and mitochondrial abnormalities[J]. Gastroenterology, 2001, 120(5): 1183-1192.
Donnelly KL, Smith CI, Schwarzenberg SJ, et al. Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease[J]. J Clin Invest, 2005, 115(5): 1343-1351.
Lambert JE, Ramos-Roman MA, Browning JD, et al. Increased de novo lipogenesis is a distinct characteristic of individuals with nonalcoholic fatty liver disease[J]. Gastroenterology, 2014, 146(3): 726-735.
Kitae A, Hashimoto Y, Hamaguchi M, et al. The triglyceride and glucose index is a predictor of incident nonalcoholic fatty liver disease: a population-based cohort study[J]. Can J Gastroenterol Hepatol, 2019, 2019: 5121574.
Kahn BB, Flier JS. Obesity and insulin resistance[J]. J Clin Invest, 2000, 106(4): 473-481.
Tirosh A, Shai I, Bitzur R, et al. Changes in triglyceride levels over time and risk of type 2 diabetes in young men[J]. Diabetes Care, 2008, 31(10): 2032-2037.
Song K, Lee HW, Choi HS, et al. Comparison of the modified TyG indices and other parameters to predict non-alcoholic fatty liver disease in youth[J]. Biology(Basel), 2022, 11(5): 685.
Xue Y, Xu JH, Li M, et al. Potential screening indicators for early diagnosis of NAFLD/MAFLD and liver fibrosis: Triglyceride glucose index-related parameters[J]. Front Endocrinol (Lausanne), 2022, 13: 951689.
Hu HF, Han Y, Cao CC, et al. The triglyceride glucose-body mass index: a non-invasive index that identifies non-alcoholic fatty liver disease in the general Japanese population[J]. J Transl Med, 2022, 20(1): 398.
Yang Z, Yu B, Wang ZH, et al. Comparison of the prognostic value of a comprehensive set of predictors in identifying risk of metabolic-associated fatty liver disease among employed adults[J]. BMC Public Health, 2023, 23(1): 584.
Zhang SJ, Du TT, Zhang JH, et al. The triglyceride and glucose index (TyG) is an effective biomarker to identify nonalcoholic fatty liver disease[J]. Lipids Health Dis, 2017, 16(1): 15.
Guo W, Lu J, Qin P, et al. The triglyceride-glucose index is associated with the severity of hepatic steatosis and the presence of liver fibrosis in non-alcoholic fatty liver disease: a cross-sectional study in Chinese adults[J]. Lipids Health Dis, 2020, 19(1): 218.
Li L, Liu DW, Yan HY, et al. Obesity is an independent risk factor for non-alcoholic fatty liver disease: evidence from a meta-analysis of 21 cohort studies[J]. Obes Rev, 2016, 17(6): 510-519.
Cuzmar V, Alberti G, Uauy R, et al. Early obesity: risk factor for fatty liver disease[J]. J Pediatr Gastroenterol Nutr, 2020, 70(1): 93-98.
Miyake T, Kumagi T, Hirooka M, et al. Body mass index is the most useful predictive factor for the onset of nonalcoholic fatty liver disease: a community-based retrospective longitudinal cohort study[J]. J Gastroenterol, 2013, 48(3): 413-422.
Wang RS, Dai LL, Zhong YJ, et al. Usefulness of the triglyceride glucose-body mass index in evaluating nonalcoholic fatty liver disease: insights from a general population[J]. Lipids Health Dis, 2021, 20(1): 77.
Kim HS, Cho YK, Kim EH, et al. Triglyceride glucose-waist circumference is superior to the homeostasis model assessment of insulin resistance in identifying nonalcoholic fatty liver disease in healthy subjects[J]. J Clin Med, 2021, 11(1): 41.
Sheng GT, Lu S, Xie QY, et al. The usefulness of obesity and lipid-related indices to predict the presence of Non-alcoholic fatty liver disease[J]. Lipids Health Dis, 2021, 20(1): 134.
Song K, Park G, Lee HS, et al. Comparison of the triglyceride glucose index and modified triglyceride glucose indices to predict nonalcoholic fatty liver disease in youths[J]. J Pediatr, 2022, 242: 79-85.e1.
Li N, Tan HW, Xie AX, et al. Value of the triglyceride glucose index combined with body mass index in identifying non-alcoholic fatty liver disease in patients with type 2 diabetes[J]. BMC Endocr Disord, 2022, 22(1): 101.
Hernaez R, Lazo M, Bonekamp S, et al. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis[J]. Hepatology, 2011, 54(3): 1082-1090.
0
浏览量
0
下载量
0
CSCD
0
CNKI被引量
- 网络PDF下载
- Meta-XML下载
- BibTeX下载
- Endnote下载
- RefMan 下载
- NoteExpress下载
- NoteFirst下载
关联资源
相关文章
相关作者
相关机构
- 技术支持由北京北大方正电子有限公司提供 京ICP备09064830号-19
京公网安备11010802024621 - 本系统建议在Chrome、 IE9+ 以上版本浏览器阅读本站内容，360浏览器请切换至极速模式
- Cookies帮助我们提供服务并提供个性化体验。使用本网站，即表示您同意我们使用Cookies