三酰甘油葡萄糖乘积指数对维持性血液透析患者腹主动脉钙化的评估价值

The value of triglycerides-glucose index in the evaluation of abdominal aortic calcification in maintenance hemodialysis patients

目的探讨三酰甘油葡萄糖(triglycerides-glucose,TyG)乘积指数对维持性血液透析(maintenance hemodialysis,MHD)患者腹主动脉钙化(abdominal aortic calcification,AAC)的评估价值。方法纳入在安徽医科大学第二附属医院肾内科住院的MHD患者,收集患者临床资料及生化指标,使用腹部侧位平片检测腹主动脉钙化情况,根据钙化评分分成腹主动脉钙化组及非钙化组。分析AAC评分与各指标的相关性,进一步探讨Ty G指数对AAC的评估价值。结果共纳入130例MHD患者,67例(51.5%)患者发生腹主动脉钙化,中重度钙化发生率为36.2%。钙化组年龄、透析龄、体质量指数(body mass index,BMI)、中性粒细胞计数、总胆固醇、三酰甘油、C反应蛋白、TyG指数均高于非钙化组(t=-3.642,P<0.001;t=-2.458,P=0.015;Z=3.776,P<0.001;Z=2.041,P=0.041;Z=2.364,P=0.018;Z=6.802,P<0.001;Z=2.113,P=0.035;Z=7.247,P<0.001)。AAC评分与年龄、BMI、总胆固醇、三酰甘油、C反应蛋白、TyG指数呈正相关(r=0.299,P=0.001;r=0.274,P=0.002;r=0.223,P=0.013;r=0.640,P<0.001;r=0.234,P=0.014;r=0.667,P<0.001)。Logistic回归分析结果显示:年龄(OR=1.060,95%CI:1.001~1.122,P=0.046)、透析龄(OR=1.027,95%CI:1.012~1.042,P<0.001)、BMI(OR=1.163,95%CI:1.016~1.331,P=0.028)及TyG指数(OR=133.874,95%CI:18.833~951.649,P<0.001)是MHD患者发生腹主动脉钙化的独立危险因素。Ty G指数诊断AAC的受试者工作特征(receiver operating characteristic,ROC)曲线下面积为0.871(截点8.58,敏感度为80.0%,特异度为84.1%,95%CI:0.812~0.931,P<0.001)。结论MHD患者腹主动脉钙化发生率较高,TyG指数与腹主动脉钙化相关,对腹主动脉钙化的发生有较好的预测价值。

Objective To explore the value of triglycerides-glucose(TyG)index in the evaluation of abdominal aortic calcification(AAC)in maintenance hemodialysis(MHD)patients.Method The MHD patients hospitalized in the Nephrology Department of the Second Affiliated Hospital of Anhui Medical University were enrolled in this study.Their clinical data and biochemical parameters were recruited and the AAC scores was evaluated by abdominal lateral X-ray film.Based on AAC score,the patients were divided into non-AAC group and AAC group.The correlation between AAC score and clinical parameters were analyzed to explore the value of TyG index in the evaluation of AAC.Results In the 130 MHD patients enrolled in this study,AAC was found in 67 patients(51.5%),in which 36.2%had moderate to severe AAC.Compared with non-AAC group,age(t=-3.642,P<0.001),dialysis age(t=-2.458,P=0.015),BMI(Z=3.776,P<0.001),neutrophil count(Z=2.041,P=0.041),total cholesterol(Z=2.364,P=0.018),triglyceride(Z=6.802,P<0.001),C-reative protein(Z=2.113,P=0.035)and TyG index(Z=7.247,P<0.001)were higher in AAC group.AAC score was positively correlated with age,BMI,total cholesterol,triglyceride,C-creative protein and TyG index(r=0.299,0.274,0.223,0.640,0.234 and 0.667 respectively;P=0.001,0.002,0.013,<0.001,0.014 and<0.001 respectively).Logistic regression analysis showed that age(OR=1.060,95%CI:1.001~1.122,P=0.046),dialysis age(OR=1.027,95%CI:1.012~1.042,P<.001),BMI(OR=0.163,95%CI:11.016~1.331,P=0.028),and TyG index(OR=133.874,95%CI:18.833~951.649,P<0.001)were the independent risk factors for AAC in MHD patients.The area under receiver operating characteristic(ROC)curve of TyG indexforAACwas0.871,withthe cutoffpoint of 8.58,sensitivity of 80.0%,and specificity of 84.1%(95%CI:0.812~0.931,P<0.001).Conclusion The incidence of AAC is high in MHD patients.TyG index is correlated with AAC,and has a better predictive value for AAC in MHD patients.