基于陕北煤矿人群的胰岛素抵抗与心血管疾病风险的关联研究

Study on the relationship between insulin resistance and cardiovascular disease risk based on a coal mining population in Northern Shaanxi

目的 探索煤矿人群胰岛素抵抗(insulin resistance, IR)与心血管疾病风险之间的关系。方法 数据来自2020―2023年建立的陕北煤矿工人队列的横断面研究,根据三酰甘油(triglyceride, TG)和空腹血糖(fasting plasma glucose, FPG)构建反映机体IR的三酰甘油-葡萄糖(triglycerides-glucose, TyG)指数和三酰甘油-葡萄糖-BMI (triglycerides glucose-BMI,TyG-BMI),以性别、年龄、腰围、血压、胆固醇、是否吸烟、疾病史以及地域特征计算心血管疾病风险预测(prediction for ASCVD risk, PAR)。BMI分组:BMI<18.5 kg/m^(2)为体重过低组,18.5≤BMI≤24.0 kg/m^(2)为正常组,24.0<BMI<28.0kg/m^(2)为超重组,BMI≥28.0 kg/m^(2)为肥胖组。TyG和TyG-BMI均按其三分位分为T_(1)、T_(2)、T_(3)组,以T_(1)组作为参照组。采用logistic回归分析模型探索IR与心血管疾病风险之间的关系。结果 共有4 359名研究对象纳入分析,调整混杂因素后,TyG每增加1个单位,高PAR增加27.6%(OR=1.276, 95%CI:1.193~1.365),TyG处于T3组人群高PAR是T_(1)组的3.013倍(OR=3.013, 95%CI:2.341~3.879)。敏感性分析和亚组分析进一步验证了TyG与PAR关联稳定。在正常组人群中,TyG每增加1个单位,高PAR增加29.1%(OR=1.291, 95%CI:1.171~1.422),TyG处于T_(3)组人群高PAR的风险是T_(1)组的3.658倍(OR=3.658, 95%CI:2.550~5.247);在超重组人群中,TyG每增加1个单位,高PAR增加56.9%(OR=1.569, 95%CI:1.402~1.756),TyG处于T_(3)组人群的高PAR是T_(1)组的5.610倍(OR=5.610, 95%CI:3.753~8.386);在肥胖组人群中,TyG每增加1个单位,高PAR增加47.5%(OR=1.475, 95%CI:1.211~1.796),TyG处于T_(3)组人群高PAR是T_(1)组的4.147倍(OR=4.147, 95%CI:2.254~7.628);在体重过低组人群中,TyG与PAR差异无统计学意义(P>0.05)。结论 在煤矿人群中,机体IR水平升高与心血管疾病风险的发展密切相关,BMI可能调节了两者之间的关系。在超重或肥胖早期,预防机体IR水平升高对于动脉粥样硬化性心血管病风险的防控可能具有积极作用。

Objective To investigate the relationship between insulin resistance(IR)and cardiovascular disease(CVD)risk in a population of miners.Methods The data were collected from a cross-sectional study of a group of coal miners in Northern Shaanxi Province between 2020 and 2023.TyG/TyG-BMI was developed to indicate insulin resistance in the body based on TG and FPG levels,while the Prediction for ASCVD Risk(PAR)was created to assess the risk of cardiovascular disease using factors including sex,age,waist circumference,blood pressure,cholesterol levels,smoking habits,medical history,and geographic location.BMI group:underweight group with BMI<18.5 kg/m^(2),normal group with BMI≤24.0 kg/m^(2),overweight group with BMI<28.0 kg/m^(2) and obesity group with BMI≥28.0 kg/m^(2).The TyG and TyG-BMI variables were divided into three groups(T_(1),T_(2),and T_(3))according to their tertiles,with the T_(1) group serving as the reference group.To explore the association between insulin resistance and the risk of cardiovascular disease,a logistic regression model was employed.Results Totally 4359 subjects were included.After adjusting for covariates,each unit increases in the TyG increased high PAR by 27.6%(OR=1.276,95%CI:1.193-1.365).The high PAR in the group with the TyG in T_(3) was 3.013 times of that in the group T_(1)(OR=3.013,95%CI:2.341-3.879).Sensitivity analysis and the subgroup analysis confirmed the stability of the association between the TyG and the PAR.In the general population,for every unit increase in the TyG as a continuous variable,the high PAR increased by 29.1%(OR=1.291,95%CI:1.171-1.422).As a categorical variable,the risk for high PAR in the T_(3) group was 3.658 times of that in the T_(1) group(OR=3.658,95%CI:2.550-5.247).In the hyperreconstituted population,for every unit increase in the TyG as a continuous variable,the risk for high PAR increase by 56.9%(OR=1.569,95%CI:1.402-1.756).As a categorical variable,the risk for high PAR in the T3 group was 5.610 times of that in the T_(1) group(OR=5.610,95%CI:3.753-8.386).In the obese population,for every unit increased in the TyG as a continuous variable,the high PAR increased by 47.5%(OR=1.475,95%CI:1.211-1.796).As a categorical variable,the risk for high PAR in the T_(3) group was 4.147 times of that in the T_(1) group(OR=4.147,95%CI:2.254-7.628).No statistically significant association existed between TyG and PAR in individuals with the obese population.Conclusions In coal mining populations,elevated levels of body insulin resistance strongly associates with an increased risk of developing cardiovascular disease.BMI may modulate this relationship.Early suppression of elevated levels of body insulin resistance,before the onset of overweight or obesity,may positively influence the prevention and control of atherosclerotic cardiovascular disease.