甘油三酯-葡萄糖指数与脑小血管病及其影像学标志物关系研究

doi:10.3969/j.issn.1672-6731.2023.11.007

摘要/Abstract

摘要：

目的: 探讨甘油三酯-葡萄糖(TyG)指数与脑小血管病总负荷和脑小血管病影像学标志物的关系。方法: 纳入河北医科大学第三医院2020年1月至2022年5月确诊的202例脑小血管病患者，收集临床资料并计算TyG指数；MRI评估腔隙、脑微出血、脑白质高信号和扩大的血管周围间隙，计算脑小血管病总负荷评分。结果: (1) TyG指数与脑小血管病总负荷：Logistic回归分析显示，男性(OR=2.245，95%CI：1.017~4.957；P=0.045)、年龄增大(OR=1.084，95%CI：1.046~1.124；P=0.000)、高血压(OR=2.457，95%CI：1.189~5.078；P=0.015)和TyG指数升高(OR=2.657，95%CI：1.353~5.216；P=0.005)是中重度脑小血管病总负荷的危险因素。(2) TyG指数与脑小血管病影像学标志物：Logistic回归分析显示，TyG指数升高是中重度脑白质高信号(OR=2.313，95%CI：1.095~4.885；P=0.028)、脑微出血(OR=1.690，95%CI：1.011~2.824；P=0.045)、腔隙(OR=2.087，95%CI：1.235~3.525；P=0.006)和中重度基底节区扩大的血管周围间隙(OR=2.005，95%CI：1.190~3.378；P=0.009)的危险因素。结论: TyG指数与脑小血管病总负荷及其各项影像学标志物之间均存在关联性，可作为评估脑小血管病及其严重程度的生物学标志物。

关键词: 大脑小血管疾病, 甘油三酯类, 葡萄糖, 胰岛素抵抗, 危险因素, Logistic模型

Abstract:

Objective: To investigate the relationship between triglyceride glucose (TyG) index and the total load of cerebral small vessel disease (CSVD) and its different imaging markers. Methods: A total of 202 patients with CSVD admitted to The Third Hospital of Hebei Medical University from January 2020 to May 2022 were selected. The clinical data of all patients were collected and TyG index was calculated. The lacunes, cerebral microbleeds (CMBs), white matter hyperintensity (WMH) and enlarged perivascular space (EPVS) were evaluated by MRI, and total load of CSVD score was calculated. Results: 1) TyG index and total load of CSVD score: Logistic regression analysis showed the male (OR=2.245, 95%CI: 1.017-4.957; P=0.045), increase of age (OR=1.084, 95%CI: 1.046-1.124; P=0.000), hypertension (OR=2.457, 95%CI: 1.189-5.078; P=0.015) and increase of TyG index (OR=2.657, 95%CI: 1.353-5.216; P=0.005) were risk factors for moderate and severe total load of CSVD. 2) TyG index and imaging markers of CSVD: Logistic regression analysis showed the increase of TyG index was the risk factor of moderate and severe WMH (OR=2.313, 95%CI: 1.095-4.885; P=0.028), CMBs (OR=1.690, 95%CI: 1.011-2.824; P=0.045), lacunes (OR=2.087, 95%CI: 1.235-3.525; P=0.006), moderate and severe EPVS in basal ganglia (OR=2.005, 95%CI: 1.190-3.378; P=0.009). Conclusions: TyG index is associated with the total load and various imaging markers of CSVD, which can be used as a valuable biomarker to evaluate CSVD and its severity.

Key words: Cerebral small vessel disease, Triglycerides, Glucose, Insulin resistance, Risk factors, Logistic models

尹园园, 罗伟刚, 刘万虎, 步玮, 徐玉珠, 曹晓芸, 任慧玲. 甘油三酯-葡萄糖指数与脑小血管病及其影像学标志物关系研究[J]. 中国现代神经疾病杂志, 2023, 23(11): 993-1000.

Yuan-yuan YIN, Wei-gang LUO, Wan-hu LIU, Wei BU, Yu-zhu XU, Xiao-yun CAO, Hui-ling REN. Study on the relationship between triglyceride glucose index and cerebral small vessel disease and its different imaging markers[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(11): 993-1000.

http://journal11.magtechjournal.com/cjcnn/CN/Y2023/V23/I11/993

图/表 15

参考文献 28

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观察指标	轻度总负荷组(n = 91)	中重度总负荷组(n = 111)	统计量值	P值
性别[例(%)]			1.634	0.201
男性	51(56.04)	72(64.86)
女性	40(43.96)	39(35.14)
年龄($\bar x \pm s$，岁)	63.92 ± 10.56	69.98 ± 9.98	- 4.184	0.000
吸烟[例(%)]	26(28.57)	37(33.33)	0.528	0.467
饮酒[例(%)]	23(25.27)	33(29.73)	0.495	0.482
入院时收缩压($\bar x \pm s$，mm Hg)	148.84 ± 21.09	150.67 ± 20.32	- 0.627	0.532
入院时舒张压($\bar x \pm s$，mm Hg)	87.75 ± 13.64	86.19 ± 13.88	0.800	0.425
高血压[例(%)]	60(65.93)	91(81.98)	6.823	0.009
糖尿病[例(%)]	34(37.36)	50(45.05)	1.215	0.270
冠心病[例(%)]	19(20.88)	20(18.02)	0.263	0.608
高脂血症[例(%)]	28(30.77)	34(30.63)	0.000	0.983
空腹血糖[M(P₂₅，P₇₅)，mmol/L]	5.35 (4.80，6.30)	5.70 (5.00，7.00)	- 2.247	0.025
TC($\bar x \pm s$，mmol/L)	4.40 ± 0.96	4.37 ± 1.24	0.191	0.848
TG[M(P₂₅，P₇₅)，mmol/L]	1.03 (0.80，1.39)	1.15 (0.87，1.66)	- 1.779	0.075
LDL-C($\bar x \pm s$，mmol/L)	2.60 ± 0.72	2.51 ± 0.89	0.785	0.434
HDL-C[M(P₂₅，P₇₅)，mmol/L]	1.16 (0.97，1.35)	1.11 (0.93，1.33)	- 1.104	0.269
Hcy[M(P₂₅，P₇₅)，mmol/L]	13.75 (11.25，18.25)	14.90 (12.10，18.30)	- 1.384	0.166
TyG指数[M(P₂₅，P₇₅)]	8.42 (8.19，8.75)	8.62 (8.25，9.09)	- 2.388	0.017

观察指标	轻度总负荷组(n = 91)	中重度总负荷组(n = 111)	统计量值	P值
性别[例(%)]			1.634	0.201
男性	51(56.04)	72(64.86)
女性	40(43.96)	39(35.14)
年龄($\bar x \pm s$，岁)	63.92 ± 10.56	69.98 ± 9.98	- 4.184	0.000
吸烟[例(%)]	26(28.57)	37(33.33)	0.528	0.467
饮酒[例(%)]	23(25.27)	33(29.73)	0.495	0.482
入院时收缩压($\bar x \pm s$，mm Hg)	148.84 ± 21.09	150.67 ± 20.32	- 0.627	0.532
入院时舒张压($\bar x \pm s$，mm Hg)	87.75 ± 13.64	86.19 ± 13.88	0.800	0.425
高血压[例(%)]	60(65.93)	91(81.98)	6.823	0.009
糖尿病[例(%)]	34(37.36)	50(45.05)	1.215	0.270
冠心病[例(%)]	19(20.88)	20(18.02)	0.263	0.608
高脂血症[例(%)]	28(30.77)	34(30.63)	0.000	0.983
空腹血糖[M(P₂₅，P₇₅)，mmol/L]	5.35 (4.80，6.30)	5.70 (5.00，7.00)	- 2.247	0.025
TC($\bar x \pm s$，mmol/L)	4.40 ± 0.96	4.37 ± 1.24	0.191	0.848
TG[M(P₂₅，P₇₅)，mmol/L]	1.03 (0.80，1.39)	1.15 (0.87，1.66)	- 1.779	0.075
LDL-C($\bar x \pm s$，mmol/L)	2.60 ± 0.72	2.51 ± 0.89	0.785	0.434
HDL-C[M(P₂₅，P₇₅)，mmol/L]	1.16 (0.97，1.35)	1.11 (0.93，1.33)	- 1.104	0.269
Hcy[M(P₂₅，P₇₅)，mmol/L]	13.75 (11.25，18.25)	14.90 (12.10，18.30)	- 1.384	0.166
TyG指数[M(P₂₅，P₇₅)]	8.42 (8.19，8.75)	8.62 (8.25，9.09)	- 2.388	0.017

变量	赋值
变量	0	1
脑小血管病总负荷	轻度负荷	中重度负荷
性别	女性	男性
吸烟	无	有
饮酒	无	有
高血压	无	有
高脂血症	无	有
糖尿病	无	有
冠心病	无	有

变量	赋值
变量	0	1
脑小血管病总负荷	轻度负荷	中重度负荷
性别	女性	男性
吸烟	无	有
饮酒	无	有
高血压	无	有
高脂血症	无	有
糖尿病	无	有
冠心病	无	有

变量	b	SE	Wald χ²	P值	OR值	OR 95%CI
性别	- 0.370	0.290	1.628	0.202	0.691	0.391 ~ 1.219
年龄	0.058	0.015	15.123	0.000	1.059	1.029 ~ 1.090
吸烟	0.223	0.307	0.528	0.468	1.250	0.685 ~ 2.283
饮酒	0.224	0.318	0.494	0.482	1.251	0.670 ~ 2.334
高血压	0.855	0.332	6.647	0.010	2.351	1.227 ~ 4.502
糖尿病	0.318	0.289	1.212	0.271	1.374	0.780 ~ 2.420
冠心病	- 0.183	0.357	0.262	0.609	0.833	0.414 ~ 1.677
高脂血症	- 0.007	0.307	0.000	0.983	0.994	0.545 ~ 1.812
收缩压	0.004	0.007	0.395	0.530	1.004	0.991 ~ 1.018
舒张压	- 0.008	0.010	0.642	0.423	0.992	0.972 ~ 1.012
空腹血糖	0.153	0.086	3.151	0.076	1.166	0.984 ~ 1.381
TC	- 0.024	0.126	0.035	0.851	0.977	0.762 ~ 1.251
TG	0.504	0.229	4.835	0.028	1.655	1.056 ~ 2.592
LDL-C	- 0.136	0.177	0.594	0.441	0.873	0.617 ~ 1.234
HDL-C	- 0.458	0.494	0.860	0.354	0.633	0.240 ~ 1.665
Hcy	0.018	0.014	1.476	0.224	1.018	0.989 ~ 1.047
TyG指数	0.673	0.257	6.881	0.009	1.960	1.186 ~ 3.242

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2 甘油三酯-葡萄糖指数与脑小血管病及其影像学标志物关系研究

Study on the relationship between triglyceride glucose index and cerebral small vessel disease and its different imaging markers

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观察指标	低TyG指数组(n = 133)	高TyG指数组(n = 69)	统计量值	P值
性别[例(%)]			4.548	0.033
男性	88(66.17)	35(50.72)
女性	45(33.83)	34(49.28)
年龄($\bar x \pm s$，岁)	66.86 ± 10.94	68.00 ± 10.10	- 0.718	0.474
吸烟[例(%)]	43(32.33)	20(28.99)	0.237	0.626
饮酒[例(%)]	41(30.83)	15(21.74)	1.837	0.171
入院时收缩压($\bar x \pm s$，mm Hg)	148.69 ± 20.84	152.06 ± 20.19	- 1.100	0.273
入院时舒张压($\bar x \pm s$，mm Hg)	87.41 ± 13.93	85.88 ± 13.46	0.749	0.455
空腹血糖[M(P₂₅，P₇₅)，mmol/L]	5.20 (4.70，5.90)	6.65 (5.60，8.48)	- 6.776	0.000
高血压[例(%)]	100(75.19)	51(73.91)	0.039	0.843
糖尿病[例(%)]	41(30.83)	43(62.32)	18.547	0.000
冠心病[例(%)]	21(15.80)	18(26.09)	3.092	0.079
高脂血症[例(%)]	23(17.29)	39(56.52)	32.865	0.000
WMH总评分[M(P₂₅，P₇₅)，评分]	3.00 (2.00，5.00)	4.00 (3.00，5.00)	- 3.161	0.002
存在腔隙[例(%)]	62(46.62)	44(63.77)	5.359	0.021
存在脑微出血灶[例(%)]	59(44.36)	38(55.07)	2.088	0.148
中重度EPVS[例(%)]	26(19.55)	24(34.78)	5.660	0.017
CSVD总负荷评分[M(P₂₅，P₇₅)，评分]	1.00 (0.00，3.00)	2.00 (1.00，3.00)	- 2.919	0.004
TC($\bar x \pm s$，mmol/L)	4.18 ± 1.02	4.76 ± 1.22	- 3.570	0.000
TG[M(P₂₅，P₇₅)，mmol/L]	0.94 (0.72，1.15)	1.83 (1.48，2.24)	- 10.172	0.000
LDL-C($\bar x \pm s$，mmol/L)	2.42 ± 0.78	2.83 ± 0.84	- 3.355	0.001
HDL-C[M(P₂₅，P₇₅)，mmol/L]	1.16 (0.97，1.37)	1.09 (0.91，1.21)	- 2.651	0.008
Hcy[M(P₂₅，P₇₅)，mmol/L]	14.60 (12.00，18.60)	14.00 (11.35，17.20)	- 0.799	0.425

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变量	b	SE	Wald χ²	P值	OR值	OR 95%CI
性别	0.809	0.404	4.006	0.045	2.245	1.017 ~ 4.957
年龄	0.081	0.019	19.069	0.000	1.084	1.046 ~ 1.124
吸烟	0.370	0.410	0.814	0.367	1.448	0.648 ~ 3.236
高血压	0.899	0.370	5.889	0.015	2.457	1.189 ~ 5.078
高脂血症	- 0.001	0.405	0.000	0.998	0.999	0.452 ~ 2.210
糖尿病	- 0.307	0.368	0.696	0.404	0.736	0.358 ~ 1.513
Hcy	0.011	0.015	0.553	0.457	1.011	0.982 ~ 1.042
TyG指数	0.977	0.344	8.058	0.005	2.657	1.353 ~ 5.216
常数项	- 14.956	3.341	20.038	0.000

变量	b	SE	Wald χ²	P值	OR值	OR 95%CI
性别	0.809	0.404	4.006	0.045	2.245	1.017 ~ 4.957
年龄	0.081	0.019	19.069	0.000	1.084	1.046 ~ 1.124
吸烟	0.370	0.410	0.814	0.367	1.448	0.648 ~ 3.236
高血压	0.899	0.370	5.889	0.015	2.457	1.189 ~ 5.078
高脂血症	- 0.001	0.405	0.000	0.998	0.999	0.452 ~ 2.210
糖尿病	- 0.307	0.368	0.696	0.404	0.736	0.358 ~ 1.513
Hcy	0.011	0.015	0.553	0.457	1.011	0.982 ~ 1.042
TyG指数	0.977	0.344	8.058	0.005	2.657	1.353 ~ 5.216
常数项	- 14.956	3.341	20.038	0.000

变量	b	SE	Wald χ²	P值	OR值	OR 95%CI
年龄	0.075	0.018	18.137	0.000	1.077	1.041 ~ 1.115
高血压	0.491	0.360	1.860	0.173	1.635	0.807 ~ 3.312
高脂血症	0.547	0.383	2.037	0.154	1.727	0.815 ~ 3.659
糖尿病	0.622	0.350	3.155	0.076	1.862	0.938 ~ 3.697
Hcy	0.033	0.023	1.990	0.158	1.033	0.987 ~ 1.081
TyG指数	0.836	0.320	6.823	0.009	2.306	1.232 ~ 4.317

变量	b	SE	Wald χ²	P值	OR值	OR 95%CI
年龄	0.075	0.018	18.137	0.000	1.077	1.041 ~ 1.115
高血压	0.491	0.360	1.860	0.173	1.635	0.807 ~ 3.312
高脂血症	0.547	0.383	2.037	0.154	1.727	0.815 ~ 3.659
糖尿病	0.622	0.350	3.155	0.076	1.862	0.938 ~ 3.697
Hcy	0.033	0.023	1.990	0.158	1.033	0.987 ~ 1.081
TyG指数	0.836	0.320	6.823	0.009	2.306	1.232 ~ 4.317

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2 甘油三酯-葡萄糖指数与脑小血管病及其影像学标志物关系研究

Study on the relationship between triglyceride glucose index and cerebral small vessel disease and its different imaging markers

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