高血压伴阻塞性睡眠呼吸暂停患者甘油三酯-血糖-腰围指数与新发卒中的关系

Association between the triglyceride-glucose-waist circumference index and new-onset stroke in hypertensive patients with obstructive sleep apnea:an observational cohort study

目的探讨与高血压合并阻塞性睡眠呼吸暂停(Obstructive sleep apnea,OSA)患者新发卒中发生风险的关系。方法选取2011年1月—2013年12月在新疆维吾尔自治区人民医院高血压诊疗研究中心就诊的年龄≥18岁的合并OSA的高血压患者作为研究对象进行回顾性队列研究。共纳入2205例无卒中病史的高血压合并OSA患者作为研究对象,根据甘油三酯-血糖-腰围指数(triglyceride-glucose-waist circumference,TyG-WC)四分位数(565.9~823.4,823.5~899.1,899.2~975.4和975.5~1269.7)分为四组,分别为Q1、Q2、Q3和Q4。收集研究对象的一般资料和生化指标检测结果,使用多变量Cox比例风险回归模型(Cox regression model,Cox模型)分析TyG-WC与高血压合并OSA患者新发卒中发生风险的关系。采用广义加性模型来识别关联关系,并进行了分层分析和交互作用检验。结果与Q1组相比,TyG-WC指数较高的Q4组更年轻,男性、吸烟者和饮酒者较多,舒张压、新发卒中、糖尿病患病率较高,体质量指数(Body Mass Index,BMI)、呼吸暂停低通气指数(Apnea hypopnea index,AHI)、空腹血糖(Fasting plas ma glucose,FPG)、总胆固醇(Total choles terol,TC)、甘油三酯(Triglyceride,TG)、超敏C反应蛋白(High sen sitive C-reactive protein,hs-CRP)水平较高,高密度脂蛋白胆固醇(High density liptein cholesterol,HDL-C)水平较低,差异有统计学意义(P<0.05)。中位随访7.15年,期间共有59例患者新发卒中。在多变量调整模型中,TyG-WC与新发卒中的风险明显相关,每增加1个标准差(Standard deviation,SD),风险比率(Hazard Ratio,HR)为2.34(95%CI 1.79~3.06)。卒中的风险随着TyG-WC四分位数的增加而增加,Q4与Q1相比,HR值为6.62,差异有统计学意义(95%CI 2.52~17.38,P<0.01)。广义加性模型和平滑曲线拟合结果表明,TyG-WC与新发卒中风险之间存在线性相关。分层分析中,TyG-WC指数与新发卒中的其他潜在危险因素之间无交互作用。结论基线TyG-WC水平升高与新发卒中的风险增加相关,为早期预防高血压合并OSA患者新发卒中提供了一个有用和方便的标志物。

Objective To determine the relationship between the triglyceride-glucose-waist circumference index(TyG-WC)and the risk of new-onset stroke in patients with hypertension combined with obstructive sleep apnea(OSA).Methods This study was an observational cohort study.All patients>18 years of age who were admitted to the Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region from January 2011 to December 2013 were enrolled.A total of 2205 hypertensive patients with OSA without a history of stroke were enrolled and divided into 4 groups(Q1,Q2,Q3,and Q4)according to the TyG-WC quartile(565.9-823.4,823.5-899.1,899.2-975.4,and 975.5-1269.7).General information and biochemical test results were collected from the study subjects.Multivariate Cox regression models were used to estimate the relationship between TyG-WC and risk of first stroke,and a generalized additive model was used to identify the relationship.Additionally,we performed hierarchical analysis and a test for interactions.Results Compared with the Q1 group,the Q4 group with a higher TyG-WC index was younger,had higher percentages of males,smokers,and alcohol drinkers,a higher prevalence of first stroke and diabetes,increased body mass index(BMI),Apnea hypopnea index(AHI),higher Fasting plas ma glucose(FPG),Total choles terol(TC),Triglyceride(TG),and High sen sitive C-reactive protein(hs-CRP)concentrations,and a lower High density liptein cholesterol(HDL-C)concentration(P<0.05).During a median follow-up of 7.15 years,a total of 59 patients had a new stroke.Overall,there was a positive association between TyG-WC and new-onset stroke(per 1 SD increase;HR=2.34,95%CI 1.79-3.06).In the multivariable-adjusted model,the risk of stroke increased with quartiles of the TyG-WC;the HR in quartile 4versus quartile 1 was 6.62(95%CI 2.52-17.38,P<0.01).A generalized additive model and a smooth curve fitting showed that there was a similar linear relationship between TyG-WC and the risk of first stroke.None of the stratification variables had a significant effect on the relationship between TyG-WC and new-onset stroke.Similar outcomes were observed in the sensitivity analysis.Conclusion Elevated levels of the baseline TyG-WC were shown to be associated with an increased risk of first stroke.