不同性别中年肥胖居民三酰甘油葡萄糖乘积指数与心血管疾病高危风险的关系研究

Relationship between Triglyceride-glucose Index and Risk of Cardiovascular Diseases in Middle-aged Obese Residents of Different Genders

背景三酰甘油葡萄糖乘积(TyG)指数是评价胰岛素抵抗(IR)和肥胖相关的代谢性疾病的指标,与发生心血管疾病(CVD)高危风险密切相关,但在不同性别的中年肥胖人群中TyG指数与发生CVD高危风险可能不同。目的探讨不同性别中年肥胖人群TyG指数与发生CVD高危风险的关系,评估其在CVD防治中的作用。方法研究对象来源于安徽省开展的10个CVD高危人群早期筛查与综合干预项目,选择30425名中年肥胖居民,采用国家心血管中心统一设计的初筛调查表和基本信息登记表,由经过统一培训并考察合格的调查员进行调查,主要调查内容包括性别、年龄、高血压、血脂异常、糖尿病、吸烟情况、饮酒情况等,并进行CVD高危风险评估。将研究对象分为男性组(n=11566)和女性组(n=18859),男性组根据TyG指数四分位数分组,分为T_(1)(7.417~8.870)(n=2892)、T_(2)(8.871~9.204)(n=2891)、T_(3)(9.205~9.578)(n=2892)、T_(4)(9.579~11.435)(n=2891)亚组;女性组分为F_(1)(7.579~8.876)(n=4715)、F_(2)(8.877~9.183)(n=4720)、F_(3)(9.184~9.526)(n=4710)、F_(4)(9.527~11.647)(n=4714)亚组。采用二元Logistic回归分析探究TyG指数与发生CVD高危风险的关系,采用Z检验比较亚组间的效应值差异。结果男性组中发生CVD高危风险比例为28.4%(3280/11566),女性组中为26.0%(4909/18859)。二元Logistic回归分析结果显示,男性组(女性组)TyG指数T_(2)(F_(2))、T_(3)(F_(3))、T_(4)(F_(4))与CVD高危风险相关(P<0.05),且随着TyG指数的逐渐增大,与发生CVD高危风险的相关性也逐渐增加。男性组,与T_(1)亚组相比,T_(4)亚组发生CVD高危的风险为OR(95%CI)=1.827(1.622,2.058);女性组,与F_(1)亚组相比,F_(4)亚组发生CVD高危的风险为OR(95%CI)=1.552(1.410,1.708)。男、女两组中T_(4)亚组、F_(4)亚组TyG指数与发生CVD高危风险比较,差异有统计学意义(P<0.05);再进一步调整了总胆固醇等指标后(模型2),T_(2)(F_(2))、T_(3)(F_(3))、T_(4)(F_(4))与发生CVD高危风险的相关性有所减弱,但在男性和女性两组TyG指数中,T_(2)(F_(2))、T_(3)(F_(3))、T_(4)(F_(4))均与发生CVD高危风险存在相关性(P<0.05),且随着TyG指数水平的逐渐增大与发生CVD高危风险的相关性逐渐增加。与T_(1)亚组相比,男性组T_(4)亚组中发生CVD高危的风险为OR(95%CI)=1.804(1.584,2.055);与F_(1)亚组相比,女性组F_(4)亚组发生CVD高危风险为OR(95%CI)=1.496(1.345,1.665);男、女两组中T_(4)亚组、F_(4)亚组TyG指数与发生CVD高危风险比较,差异有统计学意义(P<0.05)。结论高水平TyG指数的中年肥胖男性更易发生CVD高危风险,应重点关注该群体的TyG指数水平。

Background Triglyceride-glucose(TyG)index is an index to evaluate insulin resistance(IR)and obesity-related metabolic diseases,which is closely related to the high risk of cardiovascular disease(CVD).However,TyG index may be different from the high risk of CVD in middle-aged obese people of different genders.Objective To investigate the relationship between TyG index and the high risk of CVD in middle-aged obese people of different genders,and to evaluate its role in the prevention and treatment of CVD.Methods A total of 30425 middle-aged obese residents were selected from 10 early screening and comprehensive intervention projects of high-risk CVD population in Anhui Province and investigated by investigators who were trained and qualified,using the preliminary screening questionnaire and basic information registration form designed by the National Cardiovascular Center.The main survey contents included gender,age,hypertension,dyslipidemia,diabetes,smoking and alcohol consumption,etc,and perform a CVD high-risk assessment.The included residents were divided into the male group(n=11566)and female group(n=18859).The male group was divided into T_(1)(7.417-8.870)(n=2892),T_(2)(8.871-9.204)(n=2891),T_(3)(9.205-9.578)(n=2892)and T_(4)(9.579-11.435)(n=2891)subgroups,the female group was divided into F_(1)(7.579-8.876)(n=4715),F_(2)(8.877-9.183)(n=4720),F_(3)(9.184-9.526)(n=4710)and F_(4)(9.527-11.647)(n=4714)subgroups according to the quartiles of TyG index.Binary Logistic regression analysis was used to explore the relationship between TyG index and the high risk of CVD,and Z-test was used to compare the differences in effect values among subgroups.Results The high risk rate of CVD was 28.4%(3280/11566)in the male group and 26.0%(4909/18859)in the female group.Binary Logistic regression analysis showed that TyG index T_(2)(F_(2)),T_(3)(F_(3)),T_(4)(F_(4))in male group(female group)were correlated with the high risk of CVD(P<0.05),and the correlation with the high risk of CVD increased with the gradual increase of TyG index.In the male group,the risk of developing high risk of CVD in the T_(4)subgroup compared to T_(1)was OR(95%CI)=1.827(1.622,2.058);In the female group,the risk of developing high risk of CVD in the F_(4)subgroup compared to F_(1)was OR(95%CI)=1.552(1.410,1.708).There were significant differences in the TyG index and risk of developing high risk of CVD between the T_(4)and F_(4)subgroups in both male and female groups(P<0.05).After further adjustment for total cholesterol and other indicators(model 2),the correlation between T_(2)(F_(2)),T_(3)(F_(3)),T_(4)(F_(4))and the risk of developing high risk of CVD was attenuated.However,in both male and female groups,T_(2)(F_(2)),T_(3)(F_(3))and T_(4)(F_(4))were all correlated with the high risk of CVD(P<0.05),and the correlation increased with the gradual increase of TyG index level.In the male group,the risk of developing high risk of CVD in the T_(4)subgroup compared to T_(1)subgroup was OR(95%CI)=1.804(1.584,2.055),in the female group,the risk of developing high risk of CVD in the F_(4)subgroup compared to F_(1)subgroup was OR(95%CI)=1.496(1.345,1.665);There were significant differences in the risk of developing high risk of CVD between the T_(4)and F_(4)subgroup in both male and female groups(P<0.05).Conclusion Middle-aged obese men with high TyG index are more prone to develop high risk for CVD,and more attention should be paid to the TyG index level of the population.