甘油三酯葡萄糖乘积指数与冠状动脉病变的相关性分析

Correlation between Triglyceride Glucose Product Index and Coronary Heart Disease

目的探讨甘油三酯葡萄糖乘积指数(triglyceride glucose product index,TyG指数)对冠心病(coronary heart disease,CHD)发生风险及冠状动脉狭窄严重程度的相关性分析。方法回顾性纳入2021年12月~2022年10月因不明原因胸痛于上海交通大学医学院附属新华医院首次行冠状动脉造影检查的患者404例,将样本分为冠心病组(n=216)及非冠心病组(n=188),收集所有入组者的基本资料、实验室数据、冠状动脉造影结果。通过倾向性评分匹配(propensity score matching,PSM)后得到冠心病组(n=123)和非冠心病组(n=123)。再根据Gensini评分中位数将冠心病患者分为低Gensini评分组(Gensini评分<35分,n=59)和高Gensini评分组(Gensini评分≥35分,n=64),比较分析各组间资料的差异,分析TyG指数与冠状动脉狭窄严重程度的相关性。并采用Logistic回归和受试者工作特征(receiver operating characteristic,ROC)曲线评估TyG指数对冠心病发生风险及冠状动脉狭窄严重程度的预测价值。结果PSM后,与非冠心病组比较,冠心病组的TyG指数、甘油三酯(triglyceride,TG)、空腹血糖(fasting plasma glucose,FPG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果提示,TyG指数可作为冠心病的独立危险因素。Spearman相关性分析结果显示,TyG指数与Gensini评分呈正相关(r=0.618,P<0.001)。ROC曲线分析结果显示,TyG指数预测高Gensini评分的曲线下面积(area under the curve,AUC)为0.873(95%CI:0.802~0.943,P<0.001)。截断值为7.08时,敏感度和特异性分别为95.2%和67.3%。结论TyG指数可作为冠心病的独立危险因素,并对冠状动脉狭窄严重程度有一定的预测价值。

Objective To investigate the correlation of triglyceride glucose product index(TyG index)with the diagnosis of coronary heart disease(CHD)and the severity of coronary stenosis.Methods A total of 404 patients who received coronary angiography for the first time in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine with unexplained chest pain from December 2021 to October 2022 were included.All subjects were divided into CHD group(n=216)and non-CHD group(n=188).General clinical data,laboratory information and coronary angiography results of all participants were collected.The CHD group(n=123)and the non-CHD group(n=123)were obtained after the propensity score matching(PSM).Patients in CHD group were further divided into low Gensini score(Gensini score<35,n=59)group and high Gensini score(Gensini score≥35,n=64)group according to the median Gensini score.The differences among groups were compared and the relation between TyG index and the severity of coronary artery stenosis was analyzed.Then the predictive value of TyG index for CHD and the severity of coronary lesion was evaluated by Logistic regression and receiver operating characteristic(ROC)curve.Results After PSM,the differences in TyG index,TG,FPG,HDL-C in CHD group were statistically significant compared with the non-CHD group(P<0.05).Multivariate Logistic regression analysis showed that the TyG index was an independent risk factor for CHD.Spearman correlation analysis showed that the TyG index was positively correlated with the Gensini score(r=0.618,P<0.001).The ROC curve analysis showed that the area under the curve(AUC)of the TyG index predicting a high Gensini score was 0.873(95%CI:0.802-0.943,P<0.001).A cut-off value was 7.08,and the sensitivity and specificity were 95.2%and 67.3%,respectively.Conclusion TyG index can be used as an independent risk factor for CHD,and has certain predictive value for the severity of coronary stenosis.