Cardiovasc Diabetol:甘油三酯血糖指数检测冠心病患者不同糖代谢状态下冠状动脉病变的严重程度

2022-06-17 从医路漫漫 MedSci原创

甘油三酯葡萄糖(TyG)指数是空腹血糖(FPG)和甘油三酯(TG)计算的组合,被认为是胰岛素抵抗(IR)的代表性生物标志物。

背景:冠心病是一种由冠状动脉硬化引起的慢性心血管疾病。由于老龄化、城市化、肥胖和不健康的生活习惯,冠心病的发病率和死亡率正在上升。因此,冠心病正在成为一个严重的公共卫生问题。2型糖尿病糖尿病(T2DM)被广泛认为是一种普遍的共病,影响冠心病的进展和这些患者的治疗选择。合并糖代谢异常的冠心病患者发生不良心血管事件的风险更高。具体来说,T2DM使患冠心病的概率和死于冠心病的风险增加至少两倍。在冠心病患者中,冠状动脉疾病(CAD)的严重程度各不相同,并通过患者的临床症状和辅助检查进行评估。

先前的研究已经发现,42.4%经历由CHD引起的心脏性猝死的个体没有临床症状;然而,尸检发现这些人患有严重的冠心病和心肌梗死。冠状动脉造影(CAG)是一种常见而准确的影像学检查,在中国被称为诊断冠心病的“金标准”。CAG可准确检测患者动脉狭窄的数目和程度。根据冠状动脉造影结果,当至少一条主要冠状动脉管腔狭窄≥50%时,定义为冠心病。病变血管的数量可以推断出冠心病的严重程度。然而,由于CAG测试的高成本或侵入性,许多患者无法进行CAG测试,因此错过了正确的医学评估。因此,有必要开发一种简单、有效且广泛适用的生物标志物来检测冠心病患者CAD的严重程度。

甘油三酯葡萄糖(TyG)指数是空腹血糖(FPG)和甘油三酯(TG)计算的组合,被认为是胰岛素抵抗(IR)的代表性生物标志物。在传统的风险因素中,FPG和甘油三酯水平与T2DM风险增加相关。

此外,一项大规模的韩国研究表明,TyG指数与动脉粥样硬化性心血管疾病相关,最近作为一种简单、低成本的动脉粥样硬化生物标志物引起了广泛关注。TyG指数也与颈动脉狭窄相关,我们之前的研究显示,在冠心病患者中,TyG指数和颈动脉斑块之间的关系显著。大量研究表明,TyG指数升高是动脉粥样硬化的独立危险因素。此外,升高的TyG指数在早期识别心血管疾病高风险个体方面具有潜在的价值。同时,冠心病的严重程度对冠心病的预后和心血管疾病的发生起着至关重要的作用。有必要在冠心病患者中识别多支冠状动脉疾病的高危人群,尤其是那些糖代谢异常的患者具有更高的风险。然而,TyG指数检测冠心病患者冠心病严重程度的能力尚未得到证实,葡萄糖代谢状态的影响需要进一步研究。

目的:本研究旨在调查冠心病患者TyG指数与冠心病严重程度之间的关系,以及不同糖代谢状态对这种关系的影响。此外,这项研究确定了TyG指数检测冠心病患者疾病严重程度的准确性。

方法:对2014年1月1日至2020年9月30日收治的731例冠心病患者进行多中心回顾性研究。所有患者按TYG指数分级(T1:5.48≤TYG指数≤7.17;T2:7.18≤TYG指数≤7.76;T3:7.77≤TYG指数≤10.82)。冠脉病变支数[单支和多支冠脉病变(≥2大血管中≥50%狭窄)]代表冠脉病变的严重程度。美国糖尿病协会将糖代谢状态定义为正常糖调节(NGR)、糖尿病前期(Pre-DM)和糖尿病(DM)。

结果:基线分析结果显示,冠心病患者的临床和生物学特征在中医辨证分型指标上有显著差异(P<0.001)。Logistic回归分析显示,TYG指数与多支冠状动脉病变的风险显著相关(优势比[OR]:1.715;95%可信区间[CI]1.339~2.197;P<0.001)。TYG指数T3与T1相比,多支冠状动脉病变的OR值为2.280(95%CI为1.530~3.398;P<0.001)。用受试者工作特征曲线评价TYG指数检测冠心病严重程度的准确性,ROC曲线下面积为0.601(95%可信区间0.559~0.643)。糖尿病患者TYG指数与多支冠状动脉病变的相关性显著,在不同糖代谢状态下的OR值最高(OR:1.717;95%CI为1.161~2.539;P<0.05)。

表1根据TyG指数三分位数的临床和生物学特征

表2根据冠心病严重程度的临床和生物学特征

表3冠心病严重程度和危险因素之间的关系

表4TyG指数和冠心病严重程度之间的关系

图1应用TyG指数检测多支冠状动脉病变的ROC曲线

表5不同糖代谢状态下TyG指数与冠心病严重程度的关系

结论:TYG指数与冠心病严重程度相关,TYG指数升高可识别多支冠状动脉病变的高危人群。糖尿病患者的TYG指数与冠脉病变严重程度相关。

 

原文出处: Su J,  Li Z,  Huang M, et al.Triglyceride glucose index for the detection of the severity of coronary artery disease in different glucose metabolic states in patients with coronary heart disease: a RCSCD-TCM study in China.Cardiovasc Diabetol 2022 Jun 06;21(1)

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    2022-11-26 docwu2019
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    2022-06-18 zz70
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    2022-06-17 杨海东

    坚持学习

    0

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