甘油三酯葡萄糖指数与重症高甘油三酯血症性胰腺炎的相关性研究

Study on the correlation between triglyceride glucose index and severe hypertriglyceridemic pancreatitis

目的探讨甘油三酯葡萄糖(TyG)指数与重症高甘油三酯血症性胰腺炎(HTGP)的相关性,为HTGP早期病情评估及临床决策提供帮助。方法回顾性收集2016年1月至2021年12月于浙江大学医学院附属邵逸夫医院确诊为HTGP的770例患者的临床资料。根据胰腺炎严重程度分为轻症急性胰腺炎(MAP)组、中度重症急性胰腺炎(MSAP)组和重症急性胰腺炎(SAP)组,比较3组间TyG指数的差异。计算所有HTGP患者TyG指数的四分位数,根据患者TyG指数分为第1四分位数(Q_(1))组、第2四分位数(Q_(2))组、第3四分位数(Q_(3))组、第4四分位数(Q_(4))组。统计各TyG指数四分位数组患者的胰腺炎严重程度分布情况。统计学方法采用Kruskal-Wallis H检验。采用Spearman相关性检验分析TyG指数四分位数组与胰腺炎严重程度之间的相关性,采用线性趋势卡方检验分析组间SAP发生率趋势,采用二元逐步logistic回归分析各TyG四分位数组与SAP发生风险之间的关系并进行趋势性检验。结果770例HTGP患者中,MAP、MSAP和SAP组分别有330例(42.9%)、268例(34.8%)和172例(22.3%)。MAP、MSAP和SAP组TyG指数分别为11.8(11.3,12.4)、12.5(11.9,13.2)和12.7(12.1,13.4),3组间差异有统计学意义(H=121.77,P<0.001)。770例患者的TyG指数为12.21(11.57,12.94),TyG指数Q_(1)组(TyG指数<11.57)、Q_(2)组(TyG指数为11.57~<12.21)、Q_(3)组(TyG指数为12.21~<12.94)和Q_(4)组(TyG指数≥12.94)分别纳入192、193、193、192例患者。TyG指数四分位数组与胰腺炎严重程度之间相关性检验差异有统计学意义(ρ=0.372,P<0.001)。TyG指数Q_(1)、Q_(2)、Q_(3)、Q_(4)组SAP发生率分别为10.9%(21/192)、14.5%(28/193)、27.5%(53/193)、36.5%(70/192),经趋势性检验差异有统计学意义(χ^(2)=44.33,P<0.001)。调整混杂因素后,以TyG指数Q_(1)组为参照,Q_(2)、Q_(3)、Q_(4)组的SAP发生风险[OR(95%置信区间)]分别为1.250(0.619~2.524)、2.882(1.506~5.514)和6.660(3.456~12.836),SAP发生风险经回归趋势性检验差异有统计学意义[OR(95%置信区间)为2.508(1.883~3.341),P<0.001]。结论HTGP患者TyG指数与胰腺炎严重程度具有相关性。随着TyG指数升高,HTGP患者的SAP发生风险增高。TyG指数或可成为重症HTGP的早期预测指标。

Objective To investigate the correlation between triglyceride glucose(TyG)index and severe hypertriglyceridemic pancreatitis(HTGP),and to provide assistance for early evaluation and clinical decision-making of HTGP.Methods From January 2016 to December 2021,the clinical data of 770 patients diagnosed with HTGP at Sir Run Run Shaw Hospital,Zhejiang University School of Medicine were retrospectively collected.According to severity of pancreatitis,the patients were divided into mild acute pancreatitis(MAP),moderate severe acute pancreatitis(MSAP)and severe acute pancreatitis(SAP)groups,and the differences in TyG index among the 3 groups was compared.According to the quartile range of the TyG index,the patients were divided into TyG Q_(1),Q_(2),Q_(3)and Q_(4)groups,and the distribution of severity of pancreatitis in each TyG index quartile group was calculated.Kruskal-Wallis H test was used for statistical analysis.Spearman correlation analysis was used to analyze the correlation between TyG index quartile range and the severity of pancreatitis.Linear trend chi-square test was used to analyze the trend of SAP incidence among groups.Binary logistic regression was used to analyze the relationship between TyG index quartile range and the risk of SAP,and the trend test was also conducted.Results A total of 770 patients with HTGP were included,among them 330(42.9%),268(34.8%)and 172(22.3%)were MAP,MSAP and SAP,respectively.The TyG indices of MAP,MSAP and SAP group were 11.8(11.3,12.4),12.5(11.9,13.2)and 12.7(12.1,13.4),respectively,and the differences among the 3 groups were statistically significant(H=121.77,P<0.001).The TyG index was 12.21(11.57,12.94)in the 770 patients.There were 192,193,193 and 192 patients enrolled in TyG Q_(1)(TyG index<11.57)、Q_(2)(TyG index ranged from 11.57 to<12.21)、Q_(3)(TyG index ranged from 12.21 to<12.94)and Q_(4)(TyG index≥12.94)group,respectively.The correlation test showed that the difference between TyG quartile range and the severity of pancreatitis was statistically significant(ρ=0.372,P<0.001).The incidence of SAP in TyG Q_(1),Q_(2),Q_(3)and Q_(4)group was 10.9%(21/192),14.5%(28/193),27.5%(53/193)and 36.5%(70/192),respectively.The trend test of SAP incidence among the TyG gruops was statistically significant(χ^(2)=44.33,P<0.001).After adjusting for confounding factors,taking the TyG Q_(1)group as a reference,the OR values of SAP risk(95%confidence interval)of the TyG Q_(2),Q_(3)and Q_(4)groups were 1.250(0.619 to 2.524),2.882(1.506 to 5.514)and 6.660(3.456 to 12.836),respectively,and the trend test of SAP risk showed a significant difference(OR=2.508,95%confidence interval 1.883 to 3.341,P<0.001).Conclusions There is a correlation between TyG index and severity of pancreatitis in patients with HTGP.As the TyG index increases,the risk of SAP increases in HTGP patients.TyG index may be an early predictor of severe HTGP.