甘油三酯葡萄糖指数和动脉硬化相关性的Meta分析

Triglyceride-glucose index and arterial stiffness:a meta-analysis

目的系统评价甘油三酯葡萄糖(triglyceride-glucose,TyG)指数和脉搏波速度(pulse wave velocity,PWV)的相关性,以探究TyG指数和动脉硬化(arterial stiffness,AS)之间的关系。方法计算机检索PubMed、Embase、Web of Science、CBM、WanFang Data和CNKI数据库,搜集TyG指数和AS相关性的观察性研究,检索时限均从建库至2024年1月14日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果共纳入16项研究。Meta分析结果表明:以臂-踝动脉脉搏波速度(baPWV)为结局参数,将TyG指数作为连续变量评估其与AS的相关性时,与低TyG指数相比,高TyG指数的人群有较高的baPWV[OR=1.48,95%CI(1.27,1.72),P<0.001];将TyG指数作为分类变量评估其与AS的相关性时观察到相似的相关性[OR=1.85,95%CI(1.67,2.04),P<0.001];以颈-股动脉脉搏波速度(cfPWV)为结局参数,将TyG指数作为连续变量评估其与AS的相关性时,与低TyG指数相比,高TyG指数的人群有较高的cfPWV[OR=1.47,95%CI(1.11,1.95),P=0.008],将TyG指数作为分类变量评估其与AS的相关性时观察到相似的相关性[OR=1.34,95%CI(1.21,1.48),P<0.001]。亚组分析结果显示,将TyG指数作为连续变量时,TyG指数和baPWV的相关性独立于性别、年龄、参与者特征以及研究类型;将TyG作为分类变量时,TyG指数和baPWV的相关性独立于年龄和参与者特征。以高baPWV定义AS,将TyG指数作为连续变量评估其对AS的影响,结果显示,与低TyG指数相比,高TyG指数的人群有较高的AS发生可能性[OR=1.51,95%CI(1.36,1.67),P<0.001];将TyG指数作为分类变量评估其与AS的相关性,观察到相似的相关性[OR=1.81,95%CI(1.48,2.21),P<0.001];以高cfPWV定义AS,将TyG作为连续变量评估其对AS的影响,结果显示,与低TyG指数相比,高TyG指数的人群有较高的AS发生可能性[OR=1.30,95%CI(1.10,1.53),P=0.02];将TyG指数作为分类变量评估其与AS的相关性,观察到相似的相关性[OR=1.60,95%CI(1.33,1.92),P<0.001]。亚组分析结果显示,将TyG指数作为连续变量时,TyG指数和AS的关联性独立于性别、参与者特征、年龄、高血压、糖尿病;将TyG作为分类变量时,TyG指数和AS的关联独立于性别、参与者特征、年龄、高血压。结论TyG指数与PWV的相关性较强,TyG指数越高,PWV越大,即AS风险越大。TyG指数可作为一项简易替代指标,用于AS的早期诊断,指导临床干预。受纳入研究数量和质量限制,上述结论尚需开展更多高质量队列研究予以验证。

Objective To systematically review the correlation between the triglyceride-glucose index(TyG index)and pulse wave velocity(PWV)and explore the relationship between the TyG index and arterial stiffness(AS).Methods The PubMed,Embase,Web of Science,CBM,WanFang Data,and CNKI databases were searched to collect observational studies on the correlation between the TyG index and AS from inception to January 14,2024.Two reviewers independently screened the literature,extracted data,and assessed the risk of bias in the included studies.Meta-analysis was performed using RevMan 5.4 software.Results A total of 16 studies were included.The results of the meta-analysis showed that when the TyG index was used as a continuous variable to evaluate its correlation with AS based on brachialankle pulse wave velocity(baPWV)as the outcome parameter,individuals with high TyG index had higher baPWV compared to those with low TyG index(OR=1.48,95%CI 1.27 to 1.72,P<0.001).Similar correlations were observed when the TyG index was used as a categorical variable to evaluate its correlation with AS(OR=1.85,95%CI 1.67 to 2.04,P<0.001).When carotid-femoral pulse wave velocity(cfPWV)was used as the outcome parameter,individuals with high TyG index had higher cfPWV compared to those with low TyG index when the TyG index was used as a continuous variable(OR=1.47,95%CI 1.11 to 1.95,P=0.008).Similar correlations were observed when the TyG index was used as a categorical variable to evaluate its correlation with AS(OR=1.34,95%CI 1.21 to 1.48,P<0.001).Subgroup analysis results showed that when the TyG index was used as a continuous variable,the correlation between the TyG index and baPWV was independent of gender,age,participant characteristics,and study type.When the TyG index was used as a categorical variable,the correlation between the TyG index and baPWV was independent of age and participant characteristics.Using high baPWV to define AS,when the TyG index was used as a continuous variable to evaluate its impact on AS,individuals with high TyG index had a higher likelihood of AS compared to those with low TyG index(OR=1.51,95%CI 1.36 to 1.67,P<0.001).Similar correlations were observed when the TyG index was used as a categorical variable to evaluate its correlation with AS(OR=1.81,95%CI 1.48 to 2.21,P<0.001).Using high cfPWV to define AS,when the TyG index was used as a continuous variable to evaluate its impact on arterial stiffness,individuals with a high TyG index had a higher likelihood of AS compared to those with a low TyG index(OR=1.30,95%CI 1.10 to 1.53,P=0.02).Similar correlations were observed when the TyG index was used as a categorical variable to evaluate its correlation with AS(OR=1.60,95%CI 1.33 to 1.92,P<0.001).Subgroup analysis results showed that when the TyG index was used as a continuous variable,the correlation between the TyG index and AS was independent of gender,participant characteristics,age,hypertension,and diabetes.When the TyG index was used as a categorical variable,the correlation between the TyG index and AS was independent of gender,participant characteristics,age,and hypertension.Conclusion There is a strong correlation between the TyG index and PWV,with a higher TyG index associated with increased PWV and greater risk of AS.The TyG index can serve as a simple alternative marker for early diagnosis of AS and guide clinical intervention.Due to the limited quantity and quality of the included studies,more high-quality studies are needed to verify the above conclusion.