南方医科大学学报 ›› 2024, Vol. 44 ›› Issue (7): 1266-1271.doi: 10.12122/j.issn.1673-4254.2024.07.06

• • 上一篇    

甘油三酯-葡萄糖指数与非肥胖型非酒精性脂肪性肝病的相关性

肖静1(), 李盈1(), 方敏2, 巩红3, 李文1, 张春艳1, 陈方尧4, 张岩1(), 韩拓1()   

  1. 1.西安交通大学第二附属医院,心血管内科,陕西 西安 710004
    2.西安交通大学第二附属医院,健康管理部,陕西 西安 710004
    2.陕西省核工业二一五医院,陕西 咸阳,712000
    4.西安交通大学公共卫生学院流行病与卫生统计学系,陕西 西安 710061
  • 收稿日期:2023-12-17 出版日期:2024-07-20 发布日期:2024-07-25
  • 通讯作者: 张岩,韩拓 E-mail:xjdyx@stu.xjtu.edu.cn;liying2021a@163.com;zy1985525@126.com;heart0228@xjtu.edu.cn
  • 作者简介:肖 静,在读硕士研究生,E-mail: xjdyx@stu.xjtu.edu.cn
    李 盈,在读博士研究生,E-mail: liying2021a@163.com
    第一联系人:(肖 静、李 盈并列第一作者)
  • 基金资助:
    国家自然科学基金青年项目(82100359);陕西省自然科学基金一般项目(2020JQ-552)

Triglyceride-glucose index in non-obese individuals: its association with and predictive value for non-alcoholic fatty liver disease

Jing XIAO1(), Ying LI1(), Min FANG2, Hong GONG3, Wen LI1, Chunyan ZHANG1, Fangyao CHEN4, Yan ZHANG1(), Tuo HAN1()   

  1. 1.Department of Cardiovascular Medicine,
    3.Department of Health Management, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
    2.Shaanxi Nuclear Industry 215th Hospital, Xianyang 712000, China
    4.Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China
  • Received:2023-12-17 Online:2024-07-20 Published:2024-07-25
  • Contact: Yan ZHANG, Tuo HAN E-mail:xjdyx@stu.xjtu.edu.cn;liying2021a@163.com;zy1985525@126.com;heart0228@xjtu.edu.cn
  • Supported by:
    Youth Program of National Natural Science Foundation of China(82100359)

摘要:

目的 探究甘油三酯-葡萄糖指数(TyG)与非肥胖型非酒精性脂肪性肝病(NAFLD)的相关性及诊断预测价值。 方法 收集2020年5月~2023年12月于我院健康体检体质量指数(BMI)<25 kg/m2的非肥胖者,根据上腹部彩超结果分为健康对照组与NAFLD组。采用限制性立方样条(RCS)探索TyG与非肥胖型NAFLD之间非线性关系,采用LASSO回归进行变量筛选,多因素Logistic回归探究TyG与非肥胖型NAFLD风险之间相关性。受试者工作特征(ROC)曲线评估TyG对非肥胖型NAFLD的诊断预测价值,并进行敏感性分析。 结果 最终纳入3723例非肥胖型体检者,其中NAFLD患者432例,患病率为11.6%。与健康对照组相比,非肥胖型NAFLD患者中收缩压、舒张压、总胆固醇、甘油三酯、LDL-C、血尿酸、空腹血糖与TyG指数升高,HDL-C降低,差异均具有统计学意义(P<0.05)。多因素Logistic回归结果显示,在充分校正混杂因素后,TyG每增加1个单位,非肥胖型NAFLD风险增加约2.22倍(OR=3.22,95% CI:2.53-4.12,P<0.001)。与最低四分位Q1组相比,TyG指数Q2、Q3、Q4组的NAFLD患病风险将分别增加1.52倍(OR=2.52,95% CI:1.20-5.95)、3.56倍(OR=4.56,95% CI:2.28-10.46)与8.66倍(OR=9.66,95% CI:4.83-22.18)。RCS曲线显示TyG指数与非肥胖型NAFLD风险显著相关,两者间呈近似线性关系(非线性检验P=0.019)。ROC曲线下面积为0.819,敏感性为78.0%,特异性为71.2%,具有较好的预测诊断价值。 结论 TyG指数与非肥胖型NAFLD发生风险显著相关,可作为健康体检人群中脂肪肝早期筛查指标。

关键词: 非肥胖型脂肪肝, 甘油三酯-葡萄糖指数, 血脂异常, 胰岛素抵抗

Abstract:

Objective To investigate the association of triglyceride-glucose index (TyG) with non-alcoholic fatty liver disease (NAFLD) and its diagnostic value for NAFLD in non-obese individuals. Methods We retrospectively collected the data of non-obese individuals (BMI<25 kg/m2) undergoing routine health examination at Second Affiliated Hospital of Xi'an Jiaotong University between May, 2020 and December, 2023, who all received abdominal ultrasound examination for NAFLD screening. The nonlinear relationship between TyG and non-obese NAFLD was explored using restricted cubic splines (RCS), and LASSO regression was used for variable screening; the correlation between TyG and NAFLD risk was analyzed using multivariate logistic regression. The diagnostic value of TyG for non-obese NAFLD was assessed using receiver-operating characteristic (ROC) curves and sensitivity analysis. Results A total of 3723 non-obese subjects were enrolled in this study, including 432 (11.6%) patients with NAFLD. Compared with the healthy individuals, the patients with NAFLD had significant elevations of systolic and diastolic blood pressures, total cholesterol, triglycerides, LDL-C, blood uric acid, fasting blood glucose, and TyG index and a decreased HDL-C level (P<0.05). Multivariate logistic regression revealed that for each one-unit increase of TyG, the risk of non-obese NAFLD increased by 2.2 folds (OR=3.22, 95% CI: 2.53-4.12, P<0.001). Compared with a TyG index in the lowest quartile Q1, a TyG index in the Q2, Q3 and Q4 quartiles was associated with an increased risk of NAFLD by 1.52 folds (OR=2.52, 95% CI: 1.20-5.95), 3.56 folds (OR=4.56, 95% CI: 2.28-10.46), and 8.66-folds (OR=9.66, 95% CI: 4.83-22.18), respectively. The RCS curve demonstrated a significant linear correlation between TyG index and non-obese NALFD risk (P for nonlinear=0.019). For diagnosing non-obese NALFD, TyG index had an area under ROC curve of 0.819 with a sensitivity of 78.0% and a specificity of 71.2%. Conclusion An increase of TyG index is correlated with increased risks of NAFLD in non-obese individuals and can serve as an indicator for screening early NAFLD in healthy individuals.

Key words: non-obese non-alcoholic fatty liver disease, triglyceride-glucose index, dyslipidemia, insulin resistance