北京城乡老年人甘油三酯-葡萄糖指数与全因死亡及心血管死亡风险的关联研究

Correlation between triglyceride-glucose index and risk of all-cause death or cardiovascular disease death in urban and rural elderly of Beijing

目的 探讨北京市城乡老年人群甘油三酯-葡萄糖(TyG)指数与全因死亡及心血管疾病(CVD)死亡风险的关联性,为明确老年人群TyG指数与全因死亡和CVD死亡的关联提供科学依据。方法 该研究数据来自北京城乡老年人群健康综合研究(BECHCS),于2009—2010年和2014年分别在北京市海淀区万寿路街道和北京市密云区选取社区老年居民(≥60岁)作为研究对象,随访截止至2021年3月31日,共纳入符合条件的北京城乡社区老年人4 499人。应用SPSS26.0和R 4.0.3软件进行方差分析、χ2检验。采用Cox比例风险回归模型分析TyG指数作为连续变量和五分位数与全因死亡、CVD死亡之间的关联。结果 4 499名研究对象平均年龄为(70.5±6.8)岁,男性1 814人(40.3%),女性2 685人(59.7%);农村老年人2 397人(53.3%),城市老年人2 102人(46.7%)。将TyG指数作为连续变量纳入Cox比例风险回归模型,结果显示,校正混杂因素后,在总人群中,TyG每增加1单位,全因死亡风险增加24.2%(HR=1.242,95%CI:1.082~1.427),CVD死亡风险增加43.4%(HR=1.434,95%CI:1.091~1.886)。在农村老年人群中TyG指数每增加1单位,全因死亡风险增加34.9%(HR=1.349,95%CI:1.093~1.664),CVD死亡风险增加62.6%(HR=1.626,95%CI:1.098~2.427)。在≥80岁、男性和女性人群中,TyG指数每增加1单位,全因死亡风险增加62.1%(HR=1.621,95%CI:1.216~2.160)、27.8%(HR=1.278,95%CI:1.046~1.562)和24.3%(HR=1.243,95%CI:1.022~1.510),CVD死亡风险增加76.2%(HR=1.762,95%CI:1.050~2.959)、68.2%(HR=1.682,95%CI:1.158~2.443)和80.2%(HR=1.802,95%CI:1.054~2.140)。将TyG指数按照五分类变量纳入模型,校正多因素后,总人群中,Q5组人群发生全因死亡和CVD死亡的风险均显著高于Q1组(HR=1.462,95%CI:1.114~1.919;HR=2.350,95%CI:1.336~4.133)。结论 北京城乡老年人群TyG指数与全因死亡和CVD死亡风险增加相关,TyG指数可作为社区老年人死亡风险预测的参考指标。

Objective To explore the correlation between triglyceride-glucose(TyG)index and risk of all-cause death or cardiovascular disease death(CVD)in urban and rural elderly of Beijing,provide the scientific basis for clarifying the correlation of TyG index and all-cause mortality and cardiovascular mortality in the elderly.Methods The data were from Beijing Elderly Comprehensive Health Cohort Study(BECHCS).In 2009-2010 and 2014,the elderly residents(≥60 years old)in Wanshou Road street of Haidian district and Miyun district in Beijing were selected as the subjects.Follow-up was performed until March 31,2021,a total of 4499 eligible elderly people in urban and rural communities in Beijing were included.ANOVA and χ^(2) test were used to analyze the data.The used software was SPSS 26.0 and R 4.0.3.A Cox proportional hazards regression model was used to analyze the correlation between the TyG index as a continuous variable and quintile and all-cause mortality or CVD mortality.Results The mean age of 4499 subjects was(70.5±6.8)years old,1814(40.3%)male and 2685(59.7%)female;including 2397(53.3%)rural elderly and 2102(46.7%)urban elderly.The TyG index was included as a continuous variable in the Cox proportional hazards regression model.The results showed that after adjusting for the confounding factors,in the total population,when per 1 unit of TyG increased,the risk of all-cause mortality increased by 24.2%(HR=1.242,95%CI:1.082-1.427),and the risk of CVD mortality increased by 43.4%(HR=1.434,95%CI:1.091-1.886).In rural elderly,when per 1 unit of TyG increased,the risk of all-cause mortality increased by 34.9%(HR=1.349,95%CI:1.093-1.664),and the risk of CVD mortality increased by 62.6%(HR=1.626,95%CI:1.098-2.427).In elderly(≥80 years old),or males and females,when per 1 unit of TyG increased,the risk of all-cause death increased by 62.1%(HR=1.621,95%CI:1.216-2.160),27.8%(HR=1.278,95%CI:1.046-1.562),24.3%(HR=1.243,95%CI:1.022-1.510);and CVD risk increased by 76.2%(HR=1.762,95%CI:1.050-2.959),68.2%(HR=1.682,95%CI:1.158-2.443)and 80.2%(HR=1.802,95%CI:1.054-2.140),respectively.When TyG index was included in the model according to five categorical variables,after adjusting for the confounding factors,in total elderly,the risk of all-cause mortality and CVD mortality in Q5 group was significantly higher than that in Q1 group(HR=1.462,95%CI:1.114-1.919;HR=2.350,95%CI:1.336-4.133).Conclusion In rural and urban elderly,the TyG index correlated to increased risk of all-cause death and CVD death.TyG index can be used as a reference indicator for mortality risk prediction in community-dwelling older adults.