甘油三酯-葡萄糖指数预测北京社区人群非致死性心脑血管疾病风险的前瞻性队列研究

The triglyceride glucose index predicts the risk of nonfatal cardio-cerebrovascular disease in the Beijing community:a prospective cohort study

目的:探讨甘油三酯-葡萄糖(TyG)指数与北京社区人群非致死性心脑血管疾病风险的关联。方法:前瞻性队列研究。2011年12月至2012年4月对北京市石景山区以及苹果园社区≥40岁的居民进行第1次基线调查,在2015年4至10月进行第2次随访调查。根据基线TyG指数水平三分位数将受试者分为3组,建立多元Cox比例风险回归模型以探索TyG指数是否为非致死性心脑血管疾病风险的独立预测因子,绘制TyG指数分组的Kaplan-Meier曲线。根据年龄、性别、体重指数、是否合并2型糖尿病、高血压和高脂血症进行亚组分析,以确定各亚组间TyG指数和非致死性心脑血管疾病之间的关联特征。结果:共纳入9577名研究对象,随访时间为(34.14±3.84)个月。随访期间,共计363例(3.8%)患者发生非致死性心脑血管疾病。Cox回归多变量分析结果提示:与低TyG指数组相比,高TyG指数组发生非致死性心脑血管疾病的风险比(HR)在未校正模型、模型1、模型2中分别为1.54(95%CI 1.19~1.98),1.60(95%CI 1.23~2.10)和1.57(95%CI 1.20~2.05)。Kaplan-Meier曲线分析显示,TyG指数由低至高组,患者发生非致死性心脑血管疾病风险升高(P=0.015)。亚组分析显示,仅性别在TyG指数和非致死性心脑血管疾病风险之间存在显著的交互作用,在女性人群中,随着TyG指数水平增长,非致死性心脑血管疾病的风险呈显著升高(P<0.001)。结论:高TyG指数与北京社区人群非致死性心脑血管疾病风险增加独立相关,性别在TyG指数和非致死性心脑血管疾病风险之间存在显著的交互作用。TyG指数可能是预测社区人群非致死性心脑血管疾病风险的有用标志物。

ObjectiveTo explore the characteristics of the association between the triglyceride glucose(TyG)index and nonfatal cardio-cerebrovascular disease risk in a community population.MethodThis was a prospective cohort study.From December 2011 to April 2012,the first investigation was conducted among subjects with more than 40-year old who were from Shijingshan district and Pingguoyuan community in Beijing.The second investigation was conducted from April to October 2015.All the subjects were divided into three groups according to the tertile of the TyG index at baseline.The multivariate Cox proportional risk regression model was established to explore the correlation between the TyG index and nonfatal cardio-cerebrovascular disease risk and the Kaplan-Meier survival curve of the TyG index group was drawn.Subgroup analyses were performed according to age,gender,body mass index,type 2 diabetes mellitus(T2DM),hypertension,and hyperlipidemia to determine the correlation characteristics between the TyG index and nonfatal cardio-cerebrovascular disease among subgroups.ResultsA total of 9577 subjects were finally included to analyze.The mean follow-up time of this study was(34.14±3.84)months.During the follow-up,363 subjects(3.8%)occurred nonfatal cardio-cerebrovascular disease.The multivariate Cox regression analysis results showed that the hazard ratio(HR)of nonfatal cardio-cerebrovascular disease in the high TyG index group was 1.54(95%CI 1.19-1.98),1.60(95%CI 1.23-2.10),and 1.57(95%CI 1.20-2.05)in the three models,compared with the low TyG index group.The Kaplan-Meier analysis showed that the risk of nonfatal cardio-cerebrovascular disease increased from the low-TyG index group to the high-TyG index group(P=0.015).In the six subgroups analysis,only gender was shown to have a significant interaction effect with the TyG index and nonfatal cardio-cerebrovascular disease risk.In the female population,the risk of nonfatal cardio-cerebrovascular disease is significantly increased with the increase in the TyG index level(P<0.001).ConclusionsA high TyG index is independently related to the increased risk of nonfatal cardio-cerebrovascular disease in the Beijing community population.Gender has a significant interaction with the TyG index and nonfatal cardio-cerebrovascular disease risk.Therefore,the TyG index may be a useful marker to predict the nonfatal cardio-cerebrovascular disease risk of a community population.