三酰甘油葡萄糖指数与动脉硬化性脑小血管病患者情感障碍的相关性研究

Correlation between triglyceride glucose index and emotional disorder in patients with arteriosclerotic cerebral small vessel disease

目的探讨三酰甘油葡萄糖(TyG)指数与动脉硬化性脑小血管病(CSVD)患者情感障碍的关系。方法回顾性连续纳入北京大学第一医院“神经系统疾病临床数据库和生物标本库”中2018年2月至2021年12月动脉硬化性CSVD就诊患者158例,包括有局灶性症状的近期皮质下小梗死患者及头痛、头晕、记忆力下降等非局灶性症状患者。收集患者的人口统计学资料(年龄、性别)、体质量指数(BMI)、受教育年限、心脑血管疾病危险因素(高血压病、糖尿病、高脂血症、缺血性心脏病、吸烟、饮酒、脑血管病家族史)、实验室指标(三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、总胆固醇、空腹血糖、血肌酐、尿酸、肾小球滤过率、同型半胱氨酸、超敏C反应蛋白),计算TyG指数,评估CSVD总体负荷评分[轻度(0分)、中度(1~2分)、重度(3~4分)]。将年龄≥65岁定义为老年,BMI≥28 kg/m^(2)定义为肥胖,低密度脂蛋白胆固醇≥2.6 mmol/L为高低密度脂蛋白胆固醇血症。所有患者于就诊7~14 d内进行认知功能[简易精神状态检查(MMSE)量表、蒙特利尔认知评估(MoCA)量表]、情感障碍[中国精神障碍分类与诊断标准第三版(精神障碍分类)结合抑郁自评量表(SDS)、焦虑自评量表(SAS)]的评估。MMSE量表评分<9分、MMSE量表评分≥9分且MoCA量表评分<26分均认为存在认知功能障碍;SDS评分≥53分为有抑郁症状,SAS评分≥50分为有焦虑症状,存在抑郁或焦虑或二者共存均判定为存在情感障碍,依此将158例分为情感障碍组(44例)和无情感障碍组(114例)。比较两组患者各项指标的差异。应用受试者工作特征(ROC)曲线分析TyG指数对CSVD合并情感障碍的预测价值,并计算曲线下面积(AUC)。将单因素分析中P<0.05和临床意义较大的项目作为自变量,应用二元Logistic回归分析(向前逐步回归法)进一步分析TyG指数与动脉硬化性CSVD患者发生情感障碍的关系。结果(1)与无情感障碍组患者相比,情感障碍组动脉硬化性CSVD患者年龄更大[(68±9)岁比(63±11)岁,t=2.769],BMI、空腹血糖、低密度脂蛋白胆固醇、同型半胱氨酸、TyG指数水平更高[25.3(23.9,27.8)kg/m^(2)比23.8(21.8,25.6)kg/m^(2),Z=3.775;(6.3±2.2)mmol/L比(5.7±1.3)mmol/L,t=2.069;2.59(2.05,3.01)mmol/L比2.18(1.78,2.90)mmol/L,Z=1.986;(17±5)μmol/L比(14±6)μmol/L,t=2.615;(9.1±0.7)比(8.5±0.6),t=4.889],SAS、SDS、CSVD总负荷评分更高[53(50,60)分比36(30,42)分,Z=9.339;53(53,62)分比36(31,43)分,Z=9.753;2(2,4)分比2(1,2)分,Z=3.741];老年、肥胖、高同型半胱氨酸血症、认知障碍、高低密度脂蛋白胆固醇血症比例更高[70.5%(31/44)比45.6%(52/114),χ^(2)=7.856;25.0%(11/44)比10.5%(12/114),χ^(2)=5.347;61.4%(27/44)比41.2%(47/114),χ^(2)=5.169;79.5%(35/44)比19.3%(22/114),χ^(2)=49.968;50.0%(22/44)比30.7%(35/114),χ^(2)=5.127];组间差异均有统计学意义(均P<0.05)。情感障碍组、无情感障碍组CSVD总负荷评分均以中度为主[分别为54.5%(24/44)、79.8%(91/114)],两组均无轻度患者,CSVD总负荷评分分布的差异有统计学意义(χ^(2)=10.242,P<0.01)。其余一般资料的组间差异均无统计学意义(均P>0.05)。(2)TyG指数预测CSVD患者情感障碍的ROC曲线分析显示,AUC为0.731(95%CI:0.642~0.821,P<0.01),最佳截断值为8.815,敏感度为72.7%(32/44),特异度为69.3%(79/114)。情感障碍组患者TyG指数≥8.815的比例高于无情感障碍组,组间差异有统计学意义[70.5%(31/44)比30.7%(35/114),χ^(2)=20.626,P<0.01]。(3)进一步行二元Logistic回归分析,结果显示,老年(OR=2.365,95%CI:1.007~5.553,P=0.048)、TyG指数≥8.815(OR=2.991,95%CI:1.182~7.567,P=0.021)、合并认知障碍(OR=13.328,95%CI:5.093~34.883,P<0.01)、重度CSVD总负荷(OR=3.392,95%CI:1.225~9.397,P=0.019)是动脉硬化性CSVD患者发生情感障碍的独立危险因素。结论高TyG指数与CSVD患者发生情感障碍独立相关,临床上应关注动脉硬化性CSVD患者的胰岛素抵抗情况。

Objective To investigate the relationship between triglyceride glucose(TyG)index and emotional disorder in patients with arteriosclerotic cerebral small vessel disease(CSVD).Methods A total of 158 consecutive patients with arteriosclerotic CSVD from February 2018 to December 2021 in the“clinical database and biospecimen bank of neurological diseases”of Peking University First Hospital were retrospectively analyzed,including patients with recent subcortical small infarction patients with focal symptoms and patients with nonfocal symptoms such as headache,dizziness and memory decline.Demographic data(age,gender),body mass index(BMI),years of education,cardiovascular and cerebrovascular disease risk factors(hypertension,diabetes mellitus,hyperlipidemia,ischemic heart disease,smoking,alcohol drinking,family history of cerebrovascular disease),laboratory indexes(triacylglycerol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,total cholesterol,fasting blood glucose,serum creatinine,uric acid,glomerular filtration rate,homocysteine,and hypersensitive C-reactive protein)were collected.TyG index was calculated,and the overall burden of CSVD were evaluated(mild[0 points],moderate[1-2 points],severe[3-4 points]).Age≥65 years old was defined as the elderly,BMI≥28 kg/m^(2)as obesity,and low-density lipoprotein cholesterol≥2.6 mmol/L as hyper-low-density lipoprotein cholesterolemia.All patients were assessed within 7-14 days of cognitive function(mini-mental state examination[MMSE]scale,Montreal cognitive assessment[MoCA]scale),emotional disorder(Chinese classification of mental disorders and diagnostic criteria version 3[classification of mental disorders]combined with self rating depression scale[SDS]and self rating anxiety scale[SAS]).The MMSE scale score<9 and the MoCA scale score<26 with the MMSE scale score≥9 were all considered to have cognitive impairment.SDS score≥53 was considered to have depressive symptoms and SAS score≥50 was considered to have anxiety symptoms.The presence of depression or anxiety,or coexistence of both were considered to have emotional disorder,and accordingly,158 patients were divided into emotional disorder group(44 cases)and non-emotional disorder group(114 cases).The differences of each index between the two groups were compared.Receiver operating characteristic(ROC)curve was applied to assess the value of TyG index for emotional disorder in CSVD patients,and the area under the cure(AUC)was calculated.Variables with P<0.05 and/or of clinical significance in univariate analysis as independent variables,binary Logistic regression analysis(forward stepwise method)was used to analyze the correlation between TyG index and emotional disorder in patients with arteriosclerotic CSVD.Results(1)Compared with patients in the non-emotional disorder group,patients with arteriosclerotic CSVD in the emotional disorder group were older([68±9]years old vs.[63±11]years old,t=2.769],and had higher BMI,fasting blood glucose,low-density lipoprotein cholesterol,homocysteine,TyG index level(25.3[23.9,27.8]kg/m^(2)vs.23.8[21.8,25.6]kg/m^(2),Z=3.775;[6.3±2.2]mmol/L vs.[5.7±1.3]mmol/L,t=2.069;2.59[2.05,3.01]mmol/L vs.2.18[1.78,2.90]mmol/L,Z=1.986;[17±5]μmol/L vs.[14±6]μmol/L,t=2.615;[9.1±0.7]vs.[8.5±0.6],t=4.889),higher SAS,SDS,total burden of CSVD score(53[50,60]vs.36[30,42],Z=9.339;53[53,62]vs.36[31,43],Z=9.753;2[2,4]vs.2[1,2],Z=3.741),higher proportion of the elderly,obesity,hyperhomocysteinemia,cognitive impairment,hyper-low-density lipoprotein cholesterolemia(70.5%[31/44]vs.45.6%[52/114],χ^(2)=7.856;25.0%[11/44]vs.10.5%[12/114],χ^(2)=5.347;61.4%[27/44]vs.41.2%[47/114],χ^(2)=5.169;79.5%[35/44]vs.19.3%[22/114],χ^(2)=49.968;50.0%[22/44]vs.30.7%[35/114],χ^(2)=5.127).All the above differences between the two groups were statistically significant(all P<0.05).The total CSVD burden of score of the emotional disorder group and the non-emotional disorder group were all of moderate predominance(54.5%[24/44],79.8%[91/114],respectively).There were no mild patients in both groups,and the difference of the distribution of CSVD total burden score was statistically significant(χ^(2)=10.242,P<0.01).There were no statistically significant differences between the two groups in the remaining general data(all P>0.05).(2)The AUC of ROC curve of TyG index to predict emotional disorders in CSVD patients was 0.731(95%CI 0.642-0.821,P<0.01);taking 8.815 as the optimal cut-off point,the sensitivity and specificity were 72.7%(32/44)and 69.3%(79/114),respectively.The proportion of patients in the emotional disorder group with TyG index≥8.815 was higher than that in the group without emotional disorder,and the difference between groups was statistically significant(70.5%[31/44]vs.30.7%[35/114],χ^(2)=20.626,P<0.01).(3)The multivariate binary Logistic regression analysis showed that old age(OR,2.365,95%CI 1.007-5.553,P=0.048),TyG index≥8.815(OR,2.991,95%CI 1.182-7.567,P=0.021),cognitive impairment(OR,13.328,95%CI 5.093-34.883,P<0.01)and severe total burden of CSVD(OR,3.392,95%CI 1.225-9.397,P=0.019)were independent risk factors for emotional disorder in arteriosclerotic CSVD patients.Conclusion High TyG index is independently associated with emotional disorder in patients with arteriosclerotic CSVD,and clinical attention should be paid to insulin resistance in these patients.