应用胰岛素抵抗替代指标预测亚临床动脉粥样硬化的价值

The value of using surrogate indicators of insulin resistance to predict subclinical atherosclerosis

目的:探讨胰岛素抵抗(IR)替代指标对亚临床动脉粥样硬化(SCAS)的预测价值。方法:选取2020年整年度在解放军联勤保障部队第九八〇医院健康医学科参加健康体检且符合条件者16568名为研究对象,按颈动脉超声结果将其分为SCAS组(内膜增厚及斑块形成n=3809)和对照组(CON)组(n=12759)。计算SCAS的总检出率,分析甘油三酯葡萄糖乘积(TyG)、TyG-体质量指数(BMI)、TyG-腰围(WC)、血浆致动脉硬化指数(AIP)、内脏脂肪指数(VAI)、脂质积累产物(LAP)等基于人体测量学和生化指标计算而得出的IR的替代指标与SCAS发生的相关性及用IR替代指标预测SCAS的价值。结果:SCAS总检出率为23%(3809/16568);SCAS组在年龄、SBP、DBP、TC、TG、LDL-C、TyG、TyG-WC、TyG-BMI、VAI、LAP、AIP水平均高于CON组(P<0.001);以SCAS为因变量,IR替代指标及相关因素作为自变量进行单因素及校正血脂四项指标后的多因素Logistic回归分析,TyG、TyGBMI、TyG-WC、VAI、LAP、AIP均为SCAS的独立危险因素(P<0.01);以SCAS为因变量进行ROC曲线分析,六种IR替代指标曲线下面积均大于0.5,对预测SCAS具有一定的价值。结论:基于人体测量学或生化指标计算而得出的IR替代指标对SCAS的预测具有一定的价值。

Objective:To explore the predictive value of substitute index of insulin resistance(IR)as subclinical atherosclerosis(SCAS).Methods:A total of 16,568 people who participated in the health check-up at NO 980 Hospital Joint Logistics Support Force,PLA,China in 2020 were selected as the research objects.According to the results of carotid artery ultrasound,the research objects were divided into SCAS group(Intimal thickening and Plaque formation n=3809)and control group(CON group)(n=12759).The total detection rate of SCAS was calculated and the surrogate indexes of IR such as TyG,TyG-WC,TyG-BMI,VAI,LAP,AIP were calculated based on anthropometric and biochemical indicators.Logistic regression analysis was used to calculate the correlation between IR’s surrogate index and the occurrence of SCAS.Results:The total detection rate of SCAS was 23%(3809/16568).The values of age,SBP,DBP,TC,TG,LDL-C,TyG,TyG-WC,TyGBMI,VAI,LAP,AIP in the SCAS group were higher than those in the CON group(P<0.001).Take SCAS as the dependent variable,and IR substitute indicators and related factors as independent variables for single factor and multiple factor Logistic regression analysis after adjusting the four items of blood lipid.The results showed that TyG,TyG-BMI,TyG-WC,VAI,LAP,AIP were all independent risk factors for SCAS(P<0.01).Taking SCAS as the dependent variable for ROC curve analysis,the areas under the curve of the six IR alternative indicators were all greater than 0.5 which indicated that the six IR substitute index had a certain value for predicting SCAS.Conclusion:The surrogate index of IR based on anthropometry or biochemical index calculation has certain value for the prediction of SCAS.