高同型半胱氨酸血症高血压患者三酰甘油葡萄糖指数与颈动脉粥样硬化的关系

Association of Triglyceride Glucose Index and Carotid Atherosclerosis in Patients with Hypertension and High Homocysteine

目的研究三酰甘油葡萄糖(triglyceride glucose,TyG)指数升高对高同型半胱氨酸(homocysteine,Hcy)血症高血压患者颈动脉粥样硬化的影响。方法本研究在一项基于社区的队列研究中招募了1457例高血压患者。高Hcy血症定义为Hcy>10μmol/L。利用血管超声检测患者颈动脉内中膜厚度(intima media thickness,IMT)和颈动脉斑块:IMT≥1.0 mm或出现斑块定义为颈动脉粥样硬化。结果高血压合并高Hcy患者(n=1229)颈动脉粥样硬化发生率为22.5%,高血压合并Hcy正常患者(n=228)颈动脉粥样硬化发生率为11.8%。对高血压合并高Hcy患者,在模型3中,TyG指数与颈动脉粥样硬化独立相关(OR=1.375,95%CI:1.122~1.685),TyG指数每增加1个单位,颈动脉粥样硬化风险增加1.375倍。对高血压合并Hcy正常患者,在模型3中,TyG指数不是颈动脉粥样硬化独立危险因素。利用受试者工作特征曲线(receiver operating characteristic curve,ROC)计算预测颈动脉粥样硬化的传统危险因素和传统危险因素加TyG指数的曲线下面积(area under the curve,AUC)分别为0.598和0.612(P<0.05)。年龄和TyG指数的交互作用P值是有统计学意义的(P均<0.001)。对于年龄≥50岁的高血压合并高Hcy患者,TyG指数与颈动脉粥样硬化的相关性更显著,独立于空腹血糖和血脂。结论TyG指数升高是高血压合并高Hcy患者颈动脉粥样硬化的独立危险因素,尤其是在≥50岁年龄段。

Objectives To research the effect of elevated triglyceride glucose(TyG)index on carotid atherosclerosis in patients with hyperhomocysteinemia and hypertension.Methods We recruited 1457 hypertensive participants from a cohort study.Homocysteine(Hcy)concentration above 10μmol/L was defined as high Hcy.Carotid intima media thickness(IMT)and plaque in carotid artery were detected by ultrasonography.IMT≥1.0 mm or plaque presence was defined as carotid atherosclerosis.Results 22.5%patients had carotid atherosclerosis in hypertension with high Hcy group(n=1229),11.8%patients had carotid atherosclerosis in hypertension with normal Hcy group(n=228).In model 3,TyG index was independently associated with carotid atherosclerosis in hypertensive patients with high Hcy(OR=1.375,95%CI:1.122-1.685),and each unit increased in TyG index was associated with a 1.375-fold increasing in carotid atherosclerosis risk.TyG index was not an independent risk factor for carotid atherosclerosis in model 3 in hypertensive subjects with normal Hcy.Area under the curve(AUC)of traditional risk factors and traditional risk factors plus TyG index for predicting carotid atherosclerosis calculated by receiver operating characteristic curv(ROC)were 0.598 and 0.612(P<0.05),respectively.The interaction P-values for age and TyG index were significant(P<0.001).For hypertensive patients aged≥50 years with high Hcy,TyG index was more significantly associated with carotid atherosclerosis,independent of fasting blood glucose and lipids.Conclusions Elevated TyG index is an independent risk factor for carotid atherosclerosis in hypertensive patients with high Hcy,especially in the age≥50 years participants.