肥胖人群甘油三酯-葡萄糖指数与非酒精性脂肪性肝炎的关联性研究

Association between triglyceride-glucose index and non‐alcoholic steatohepatitis in obese patients

目的探讨肥胖人群甘油三酯-葡萄糖(TyG)指数与非酒精性脂肪性肝炎(NASH)之间的关系。方法为横断面研究。纳入2016年1月至2023年7月在南京大学医学院附属鼓楼医院行肝脏活检的肥胖患者为研究对象。收集研究对象空腹血糖(FPG)和甘油三酯(TG)并计算其TyG指数,收集研究对象肝脏穿刺活检结果并对其肝脏组织学特征进行评估(肝脏脂肪变性评分、小叶炎症评分、气球样变性评分、肝纤维化评分)。根据肝脏病理结果将研究对象分为对照组、非NASH组和NASH组。根据TyG指数四分位数将研究对象分为Q_(1)组(TyG指数<8.48)、Q_(2)组(TyG指数8.48~8.85)、Q_(3)组(TyG指数8.86~9.27)和Q_(4)组(TyG指数>9.27)。通过简单随机抽样法将研究对象按7∶3比例分为训练集和验证集。采用线性回归分析来评估TyG指数在对照组、非NASH组和NASH组的变化趋势,采用线性相关卡方检验来评估TyG四分位数与肝脏组织学特征的关联。采用Spearman相关性分析法分析TyG指数和肝脏组织学参数之间的相关性。采用二元logistic回归分析法分析NASH的影响因素。采用受试者工作特征(ROC)曲线的曲线下面积来评估NASH风险模型预测NASH风险的性能。结果共纳入1130例行肝脏病理诊断的肥胖患者。其中,对照组126例,非NASH组715例,NASH组289例;Q_(1)组282例,Q_(2)组283例,Q_(3)组283例,Q_(4)组282例;训练集802例,验证集328例。对照组、非NASH组、NASH组的TyG指数逐渐升高[分别为8.55(8.18,8.84)、8.90(8.54,9.27)和9.12(8.68,9.52),趋势性P值<0.001]。Spearman相关性分析结果显示,TyG与肝脏脂肪变性评分、小叶炎症评分、纤维化评分均呈正相关(r值分别为0.230、0.152和0.093,P均<0.05)。Q_(1)、Q_(2)、Q_(3)、Q_(4)组4组患者的NASH患病率逐渐升高(趋势性P值<0.001)。二元logistic回归分析显示,TyG指数是NASH的独立影响因素(OR=1.825,95%CI 1.021~3.262,P=0.043)。训练集和验证集预测NASH风险的ROC曲线下面积分别为0.783(95%CI 0.747~0.818)和0.759(95%CI 0.703~0.814)。结论TyG指数是NASH的影响因素,基于TyG指数所构建的组合指标可较好预测NASH风险。

Objective To investigate the association between the triglyceride-glucose index(TyG index)and non-alcoholic steatohepatitis(NASH)in obese patients.Methods This cross-sectional study included obese patients who underwent liver biopsy at Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University from January 2016 to July 2023.Fasting plasma glucose(FPG)and triglycerides(TG)were measured to calculate the TyG index.Characteristics of liver histology,including steatosis,lobular inflammation,ballooning,and fibrosis scores,were assessed.Based on liver pathology,patients were categorized into control,non-NASH,and NASH groups.Patients were also divided into quartiles of the TyG index:Q_(1)(TyG index<8.48),Q_(2)(8.48≤TyG index≤8.85),Q_(3)(8.86≤TyG index≤9.27),and Q_(4)(TyG index>9.27).A simple random sampling method was used to divide the subjects into a training set and a validation set in a 7∶3 ratio.Linear regression was used to evaluate the trends in the TyG index across the control,non-NASH,and NASH groups.Linear-by-linear association chi-square tests investigated the associations between the quartiles of the TyG index and liver histological characteristics.Spearman′s correlation was used to analyze the relationship between the TyG index and histological parameters.Binary logistic regression was used to analyze the risk factors for NASH.The diagnostic value of the model for NASH was evaluated using the area under the receiver operating characteristic(ROC)curve.Results A total of 1130 obese patients undergoing liver pathology were included:126 in the control group,715 in the non-NASH group,and 289 in the NASH group.Patients were divided into quartiles of the TyG index:282 in Q_(1),283 in Q_(2),283 in Q_(3),and 282 in Q_(4).In addition,802 patients were assigned to the training set and 328 to the validation set.The TyG index progressively increased across the control,non-NASH,and NASH groups[8.55(8.18,8.84),8.90(8.54,9.27),and 9.12(8.68,9.52);P for trend<0.001].Spearman′s correlation indicated that the TyG index positively correlated with scores of liver steatosis,lobular inflammation,and fibrosis(r=0.230,0.152,and 0.093,respectively;P<0.05).The prevalence of NASH significantly increased across the Q_(1),Q_(2),Q_(3),and Q_(4) groups(P for trend<0.001).Binary logistic regression revealed that the TyG index was an independent predictor of NASH(OR=1.825,95%CI 1.021-3.262,P=0.043).The area under the ROC curve for predicting NASH risk was 0.783(95%CI 0.747-0.818)in the training set and 0.759(95%CI 0.703-0.814)in the validation set.Conclusion The TyG index is a significant predictor of NASH.A composite index based on the TyG index effectively predicts the risk of NASH.