甘油三酯-葡萄糖指数与糖尿病肾病的关系研究

Relationship between triglyceride-glucose index and diabetic kidney disease

目的探讨甘油三酯-葡萄糖(TyG)指数与糖尿病肾病(DKD)风险的关系。方法回顾性选择2021年9月至2022年10月金华市中心医院收治的2型糖尿病患者895例,依据是否为DKD患者分为观察组297例及对照组598例。收集两组患者的一般资料,检测TyG等实验室指标。根据TyG指数四分位数分成Q1、Q2、Q3、Q4共4组。采用logistic回归分析确定DKD的影响因素,并进行TyG指数四分位数分组比较。采用限制性立方样条曲线(RCS)分析TyG指数与DKD风险的关系。采用R软件CatPredi算法确定TyG指数与DKD风险的非线性关系转折的最佳截断值,并对TyG指数新得出的范围进行阈值效应分析。结果观察组患者年龄、高血压史、血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体拮抗剂用药、胰岛素治疗比例、糖尿病病程、收缩压、BMI、TG、TyG指数、尿酸和血肌酐高于对照组,差异均有统计学意义(均P<0.05)。与TyG指数Q1患者比较,TyG指数Q4患者的DKD风险增加了1.13倍(OR=2.13,95%CI:1.29~3.51,P=0.003)。RCS分析显示,调整混杂因素后,DKD风险与TyG指数存在非线性关系(P_(non-linear)=0.019)。CatPredi算法得出两者非线性关系转折的最佳截断值为9.35。阈值效应分析显示,TyG指数高于9.35的患者TyG指数每增加1,DKD风险就增加1.15倍(OR=2.15,95%CI:1.21~3.82,P=0.009)。结论TyG指数与DKD风险存在非线性关系,DKD风险在TyG指数较低时稳定在低水平,但在TyG指数>9.35后呈显著上升趋势,提示及早监测和控制高TyG指数或有助于降低DKD风险。

Objective To explore the relationship between triglyceride-glucose(TyG)index and diabetic kidney disease(DKD).Methods A total of 895 patients with type 2 diabetes(T2D)who treated at Jinhua Central Hospital from September 2021 to October 2022 were included in the study,including 297 cases with DKD(DKD group)and 598 cases without DKD(control group).The general data from two groups of patients were collected,and laboratory indicators such as the TyG index were tested.The patients were divided into four groups based on the quartiles of the TyG index:Q1,Q2,Q3 and Q4.Logistic regression analysis was used to identify risk factors for DKD,and TyG index quartile group comparisons were conducted.Restricted cubic spline(RCS)analysis was used to examine the relationship between DKD risk and TyG index,and the optimal cut-off point for the non-linear relationship between DKD and TyG index was determined using the R package CatPredi algorithm,followed by threshold effect analysis.Results Compared to the control group,the DKD group had higher age,higher proportion of hypertension,angiotensin-converting enzyme inhibitors/angiotensin II receptor blocker therapy and insulin therapy,longer duration of diabetes,higher systolic blood pressure and body mass index,higher triglycerides,TyG index,uric acid,and serum creatinine levels(all P<0.05).Quartile analysis of TyG index showed that compared to patients in the Q1 of TyG index,those in Q4 had a significantly higher risk of DKD(OR=2.13,95%CI:1.29~3.51,P=0.003).RCS analysis revealed a non-linear relationship between DKD and TyG index,with P_(non-linear)=0.019.The CatPredi algorithm determined the optimal cut-off value of TyG index for this relationship to be 9.35.When TyG index>9.35,for each 1 unit increase in TyG index,the risk of DKD increased by 1.15 folds(OR=2.15,95%CI:1.21~3.82,P=0.009).Conclusion There is a non-linear relationship between TyG index and DKD.When TyG index is low,the DKD risk remains stable at a low level;while it shows a significant upward trend,when TyG index exceeds 9.35,suggesting that early monitoring and control of high TyG index may help to reduce the risk of DKD.