三酰甘油血糖指数纵向轨迹对新发心脑血管疾病的影响研究

The Effect of Longitudinal Trajectories of Triglyceride-glucose Index on the New-onset Cardiovascular and Cerebrovascular Diseases

背景基线三酰甘油血糖指数(TyG)是心脑血管疾病(CVD)的重要影响因素,但目前国内外尚缺乏关于TyG纵向轨迹对新发CVD影响的前瞻性队列研究。目的探讨TyG纵向轨迹对新发CVD的影响。方法开滦研究自2006年开始,每2年进行一次随访。采用前瞻性队列研究方法,选取连续参加2006、2008、2010年度3次健康体检、三酰甘油及血糖值均完整并且无恶性肿瘤病史以及CVD史者作为观察对象。以2010年度健康体检时点为随访起点,终点事件为发生CVD或死亡,随访结束时间为2017-12-31。采用SAS Proc Traj程序建立研究对象TyG轨迹模型并分组,依据TyG纵向轨迹分为:低-稳定组、中低-稳定组、中高-稳定组、高-稳定组。收集患者一般资料及实验室观察指标,采用Cox比例风险模型分析TyG纵向轨迹对新发CVD的影响。结果纳入符合纳入、排除标准的研究对象共54258例,低-稳定组13150例(24.24%)、中低-稳定组28488例(52.50%)、中高-稳定组10808例(19.92%)、高-稳定组1812例(3.34%)。4组研究对象年龄、性别、BMI、心率、TyG2006、TyG2008、TyG2010、HDL-C、LDL-C、UA、hs-CRP、TG、FBG、ALT、吸烟、饮酒、体育锻炼、高血压、糖尿病、服用降脂药物比例比较,差异均有统计学意义(P<0.05)。研究对象随访(6.73±1.12)年,共发生CVD 2267例,其中急性心肌梗死499例,脑卒中1800例。4组患者CVD累积发病率比较,差异有统计学意义(P<0.05)。采用Cox比例风险回归模型,校正其他混杂因素后,与低-稳定组相比,中低-稳定组、中高-稳定组、高-稳定组是发生CVD的影响因素,HR(95%CI)分别是1.29(1.14,1.46)、1.40(1.20,1.63)、1.76(1.41,2.20);与低-稳定组相比,各组发生急性心肌梗死的HR(95%CI)分别是1.48(1.10,1.98)、1.91(1.36,2.69)、2.03(1.22,3.36);发生脑卒中的HR(95%CI)分别是1.23(1.07,1.42)、1.27(1.07,1.50)、1.63(1.27,2.08);发生缺血性脑卒中的HR(95%CI)分别是1.25(1.08,1.45)、1.35(1.12,1.60)、1.77(1.37,2.30)。结论TyG纵向轨迹水平升高是新发CVD的危险因素,且独立于基线TyG水平。

Background Triglyceride glucose index(TyG)at baseline is an important influencing factor of cardiovascular and cerebrovascular diseases(CVD),but there is still a lack of prospective cohort studies on the influence of TyG longitudinal trajectory on new-onset CVD at home and abroad.Objective To explore the influence of TyG longitudinal trajectory on the occurrence of new-onset CVD.Methods The Kailuan Study has been followed up every 2 years that began in 2006.A prospective cohort study method was used to select those who participated in three consecutive health examinations in 2006,2008,and 2010,with complete triacylglycerol and blood glucose levels,and no history of malignant tumors,cardiovascular and cerebrovascular diseases as the observation objects.The 2010 health check-up time point was used as the starting point for the follow-up,and the occurrence of CVD,death or the end of the follow-up(2017-12-31)was used as the end point of the follow-up.SAS Proc Traj program was used to establish the trajectory model of the research object TyG,four different groups were determine daccording to the longitudinal trajectories of TyG:low-stable group,medium and low-stable group,medium and high-stable group,and high-stable group.The general data and laboratory observation indicatorsof the patients were collected and the Cox proportional hazard model was used to analyze the influence of TyG longitudinal trajectory on new-onset CVD.Results A total of 54258 subjects meeting the inclusion criteriawere included,including 13150 cases(24.24%)in the low-stable group,28488 cases(52.50%)in the medium-low-stable group,10808 cases(19.92%)in the medium-high-stable group,and 1812 cases(3.34%)cases in the high-stable group.There were statistically significant differences in the age,gender,BMI,heart rate,TyG2006,TyG2008,TyG2010,HDL-C,LDL-C,UA,hs-CRP,TG,FBG,ALT,smoking,drinking,and physical exercise and the proportion of taking lipid-lowering drugs among different groups(P<0.05).The subjects were followed up for(6.73±1.12)years,and a total of 2267 cases of CVD occurred,including 499 cases of acute myocardial infarction and 1800 cases of stroke.There were significant difference in the cumulative incidence of CVD of patients among different TyG longitudinal trajectory groups(P<0.05).Cox regression analysis showed after adjusting for confounding factors,the HR value(95%CI)of CVD in each group were 1.29(1.14,1.46),1.40(1.20,1.63)and 1.76(1.41,2.20)when compared with the low-stable group;the HR value(95%CI)for acute myocardial infarctionwere 1.48(1.10,1.98),1.91(1.36,2.69)and 2.03(1.22,3.36)in each group when compared with the low-stable group;the HR value(95%CI)for stroke were 1.23(1.07,1.42),1.27(1.07,1.50)and 1.63(1.27,2.08)in each group;the HR value(95%CI)for ischemic strokewere 1.25(1.08,1.45),1.35(1.12,1.60)and 1.77(1.37,2.30)in each group.Conclusion The increased longitudinal trajectory of TyG index is a risk factor for the incidence of CVD and is independent of the baseline of TyG index.