三酰甘油-葡萄糖指数与脂肪组织胰岛素抵抗的关系分析

Effect of triglyceride-glucose index in evaluating adipose tissue insulin resistance

目的三酰甘油-葡萄糖(triglyceride-glucose,TyG)指数是胰岛素抵抗(insulin resistance,IR)的简易替代指标,脂肪组织IR(adipose-IR)引起的异位脂肪沉积可导致糖脂代谢紊乱。本研究旨在探讨TyG指数和adipose-IR的关系。方法纳入2019年4月至2022年3月于首都医科大学附属北京友谊医院就诊的向心性肥胖患者419例,收集患者的临床基本资料,检测患者的空腹血糖、胰岛素、血脂、糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)、游离脂肪酸等代谢相关指标。按照TyG指数中位数分为高TyG(≥9.07)组(n=209)和低TyG(<9.07)组(n=210);比较两组间糖脂代谢指标和adipose-IR指数的差异;二元Logistic回归分析TyG和adipose-IR指数之间的关系。结果高TyG组平均年龄(34.28±0.66)岁,男性76例(36.36%);低TyG组平均年龄(30.86±0.58)岁,男性66例(31.28%)。高TyG组平均年龄、男性患者占比均大于低TyG组(P<0.001)。与低TyG组相比,高TyG组adipose-IR指数[144.3(77.87,241.9)vs 104.1(63.40,174.1)]、稳态模型评估胰岛素抵抗(homeostasis model assessment of insulin resistance,HOMA-IR)指数[9.72(6.28,14.17)vs 6.00(3.64,9.84)]均显著增加(P<0.001);而高TyG组稳态模型胰岛素分泌功能(homeostasis model assessment ofβ-cell function,HOMA-β)指数明显低于低TyG组(P<0.001)。TyG指数与adipose-IR指数(r=0.310,P<0.001)、HOMA-IR指数(r=0.432,P<0.001)及HbA1c(r=0.553,P<0.001)均呈显著正相关,与HOMA-β(r=-0.397,P<0.001)呈显著负相关。二元Logistic回归分析结果显示TyG指数为adipose-IR的独立影响因素,OR值为1.004(95%CI:1.001~1.009)。结论TyG指数与adipose-IR指数呈显著正相关,高TyG预示着更严重的adipose-IR;TyG可以作为一种简易的手段用于评估肥胖患者adipose-IR。

Objective Triglyceride-glucose(TyG)index is a simple surrogate indicator for insulin resistance(IR).Ectopic fat deposition caused by adipose tissue IR(adipose-IR)can lead to glucose and lipid metabolism disorders.This study aimed to investigate the value of TyG index in evaluating adipose-IR.Methods A total of 419 patients with abdominal obesity were enrolled in the study from Beijing Friendship Hospital,Capital Medical University from April 2019 to March 2022.The general clinical data and metabolic related indicators,including fasting plasma glucose,insulin,serum lipid,glycosylated hemoglobin A1c(HbA1c),free fatty acid were evaluated.According to median value of TyG index,participants were divided into high-TyG group(n=209)and low-TyG group(n=210).The glycometabolic and lipid metabolism indexes and adipose-IR index between the two groups were compared,and Logistic regression analysis was performed with TyG index and adipose-IR index.Results The average age[(34.28±0.66)years vs(30.86±0.58)years,P<0.001]and proportion of males(36.36%vs 31.28%,P<0.001)were significantly higher in the high-TyG group than in low-TyG group.Compared with the low-TyG group,the adipose-IR index[144.3(77.87,241.9)vs 104.1(63.40,174.1),P<0.001]and homeostasis model assessment of insulin resistance(HOMA-IR)index[9.72(6.28,14.17)vs 6.00(3.64,9.84),P<0.001]were significantly increased in the high-TyG group.The homeostasis model assessment ofβ-cell function(HOMA-β)index in the high-TyG group was significantly lower than that in the low TyG group(P<0.001).The TyG index positively correlated with adipose-IR index(r=0.310,P<0.001),HOMA-IR index(r=0.432,P<0.001)and HbA1c(r=0.553,P<0.001),and negatively correlated with HOMA-β(r=-0.397,P<0.001).Bivariate Logistic regression analysis revealed that TyG index was an independent influencing factor for adipose-IR,with an odds ratio(OR)of 1.004(95%CI:1.001-1.009).Conclusion TyG index was positively correlated with adipose-IR index.High TyG index predicted more severe adipose-IR.TyG index might be used as a simple method to evaluate adipose-IR in obese patients.