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甘油三酯葡萄糖指数与冠心病患者不良预后的研究进展
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Abstract:
冠状动脉粥样硬化性心脏病(CHD)作为一种心血管疾病，严重威胁着人类生命健康。而胰岛素抵抗(IR)，不仅导致糖尿病发生，也与冠心病的发生发展密切相关，研究两者之间的关系，对冠心病的预防、诊治及随诊至关重要。胰岛素抵抗(IR)的金标准是高胰岛素正葡萄糖钳夹试验，由于其操作复杂、费时等原因限制了在临床的应用。空腹甘油三酯和葡萄糖浓度计算所得的甘油三酯葡萄糖指数(triglycerideglucose index，TyG指数)与葡萄糖钳夹技术有很好的相关性。故临床工作中常用TyG指数评价受试者的胰岛素抵抗程度。近年来，有许多研究证实了TyG与冠心病患者主要不良心血管事件(MACEs)的关系。本研究旨在总结近年来关于TyG与冠心病患者MACEs的研究进展，为冠心病患者冠脉病变严重程度的风险评估提供参考依据，对冠心病患者进行风险分层和针对性干预，延缓疾病进展、节约医疗资源、减轻个人经济负担。
Coronary atherosclerotic heart disease (CHD), as a cardiovascular disease, seriously threatens human life and health. Insulin resistance (IR) not only leads to the occurrence of diabetes, but is also closely related to the occurrence and development of coronary heart disease, and studying the relationship between the two is very important for the prevention, diagnosis and treatment of coronary heart disease. The gold standard for insulin resistance (IR) is the hyperinsulinemic euglucose clamp test, which limits its clinical application due to its complex and time-consuming operation. The triglyceride glucose index (TyG index) calculated from fasting triglycerides and glucose concentrations had a good correlation with glucose clamping techniques. Therefore, the TyG index is commonly used in clinical work to evaluate the degree of insulin resistance of subjects. In recent years, a number of studies have confirmed the association between TyG and major adverse cardiovascular events (MACEs) in patients with coronary heart disease. The purpose of this study was to summarize the research progress on TyG and MACEs in patients with coronary heart disease in recent years, to provide a reference basis for the risk assessment of the severity of coronary artery disease in patients with coronary heart disease, to carry out risk stratification and targeted intervention for patients with coronary heart disease, to delay the progression of the disease, to save medical resources, and to reduce the financial burden of individuals.
| [1] | 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2021概要[J]. 中国循环杂志, 2022, 37(6): 553-578. |
| [2] | Araújo, S.P., Juvanhol, L.L., Bressan, J. and Hermsdorff, H.H.M. (2022) Triglyceride Glucose Index: A New Biomarker in Predicting Cardiovascular Risk. Preventive Medicine Reports, 29, Article ID: 101941. https://doi.org/10.1016/j.pmedr.2022.101941 |
| [3] | Li, Q. and Yuan, J. (2023) Abstract 13237: The Combined Effect of Triglyceride-Glucose Index and High Sensitivity C-Reactive Protein on Cardiovascular Outcomes in Patients with Chronic Coronary Syndrome: A Multicenter Cohort Study. Circulation, 148, A13237. https://doi.org/10.1161/circ.148.suppl_1.13237 |
| [4] | Chen, Q., Xiong, S., Zhang, Z., Yu, X., Chen, Y., Ye, T., et al. (2023) Triglyceride-Glucose Index Is Associated with Recurrent Revascularization in Patients with Type 2 Diabetes Mellitus after Percutaneous Coronary Intervention. Cardiovascular Diabetology, 22, Article No. 284. https://doi.org/10.1186/s12933-023-02011-2 |
| [5] | DeFronzo, R.A., Tobin, J.D. and Andres, R. (1979) Glucose Clamp Technique: A Method for Quantifying Insulin Secretion and Resistance. American Journal of Physiology-Endocrinology and Metabolism, 237, E214-E223. https://doi.org/10.1152/ajpendo.1979.237.3.e214 |
| [6] | Campbell, P.J., Mandarino, L.J. and Gerich, J.E. (1988) Quantification of the Relative Impairment in Actions of Insulin on Hepatic Glucose Production and Peripheral Glucose Uptake in Non-Insulin-Dependent Diabetes Mellitus. Metabolism, 37, 15-21. https://doi.org/10.1016/0026-0495(88)90023-6 |
| [7] | Rizza, R.A., Mandarino, L.J. and Gerich, J.E. (1981) Dose-Response Characteristics for Effects of Insulin on Production and Utilization of Glucose in Man. American Journal of Physiology-Endocrinology and Metabolism, 240, E630-E639. https://doi.org/10.1152/ajpendo.1981.240.6.e630 |
| [8] | Gelfand, R.A. and Barrett, E.J. (1987) Effect of Physiologic Hyperinsulinemia on Skeletal Muscle Protein Synthesis and Breakdown in Man. Journal of Clinical Investigation, 80, 1-6. https://doi.org/10.1172/jci113033 |
| [9] | Groop, L.C., Bonadonna, R.C., DelPrato, S., Ratheiser, K., Zyck, K., Ferrannini, E., et al. (1989) Glucose and Free Fatty Acid Metabolism in Non-Insulin-Dependent Diabetes Mellitus. Evidence for Multiple Sites of Insulin Resistance. Journal of Clinical Investigation, 84, 205-213. https://doi.org/10.1172/jci114142 |
| [10] | Muniyappa, R., Lee, S., Chen, H. and Quon, M.J. (2008) Current Approaches for Assessing Insulin Sensitivity and Resistance in Vivo: Advantages, Limitations, and Appropriate Usage. American Journal of Physiology-Endocrinology and Metabolism, 294, E15-E26. https://doi.org/10.1152/ajpendo.00645.2007 |
| [11] | Shen, S., Reaven, G.M. and Farquhar, J.W. (1970) Comparison of Impedance to Insulin-Mediated Glucose Uptake in Normal Subjects and in Subjects with Latent Diabetes. Journal of Clinical Investigation, 49, 2151-2160. https://doi.org/10.1172/jci106433 |
| [12] | Matthews, D.R., Hosker, J.P., Rudenski, A.S., Naylor, B.A., Treacher, D.F. and Turner, R.C. (1985) Homeostasis Model Assessment: Insulin Resistance and β-Cell Function from Fasting Plasma Glucose and Insulin Concentrations in Man. Diabetologia, 28, 412-419. https://doi.org/10.1007/bf00280883 |
| [13] | Katz, A., Nambi, S.S., Mather, K., Baron, A.D., Follmann, D.A., Sullivan, G., et al. (2000) Quantitative Insulin Sensitivity Check Index: A Simple, Accurate Method for Assessing Insulin Sensitivity in Humans. The Journal of Clinical Endocrinology & Metabolism, 85, 2402-2410. https://doi.org/10.1210/jcem.85.7.6661 |
| [14] | Simental-Mendía, L.E., Rodríguez-Morán, M. and Guerrero-Romero, F. (2008) The Product of Fasting Glucose and Triglycerides as Surrogate for Identifying Insulin Resistance in Apparently Healthy Subjects. Metabolic Syndrome and Related Disorders, 6, 299-304. https://doi.org/10.1089/met.2008.0034 |
| [15] | Guerrero-Romero, F., Simental-Mendía, L.E., González-Ortiz, M., Martínez-Abundis, E., Ramos-Zavala, M.G., Hernández-González, S.O., et al. (2010) The Product of Triglycerides and Glucose, a Simple Measure of Insulin Sensitivity. Comparison with the Euglycemic-Hyperinsulinemic Clamp. The Journal of Clinical Endocrinology & Metabolism, 95, 3347-3351. https://doi.org/10.1210/jc.2010-0288 |
| [16] | Tao, L., Xu, J., Wang, T., Hua, F. and Li, J. (2022) Triglyceride-Glucose Index as a Marker in Cardiovascular Diseases: Landscape and Limitations. Cardiovascular Diabetology, 21, Article No. 68. https://doi.org/10.1186/s12933-022-01511-x |
| [17] | Laakso, M. and Kuusisto, J. (2014) Insulin Resistance and Hyperglycaemia in Cardiovascular Disease Development. Nature Reviews Endocrinology, 10, 293-302. https://doi.org/10.1038/nrendo.2014.29 |
| [18] | Bornfeldt, K.E. and Tabas, I. (2011) Insulin Resistance, Hyperglycemia, and Atherosclerosis. Cell Metabolism, 14, 575-585. https://doi.org/10.1016/j.cmet.2011.07.015 |
| [19] | Deloukas, P., et al. (2013) Large-Scale Association Analysis Identified New Risk Loci for Coronary Heart Disease. Nature Genetics, 45, 25-33. |
| [20] | Ginsberg, H.N., Packard, C.J., Chapman, M.J., Borén, J., Aguilar-Salinas, C.A., Averna, M., et al. (2021) Triglyceride-rich Lipoproteins and Their Remnants: Metabolic Insights, Role in Atherosclerotic Cardiovascular Disease, and Emerging Therapeutic Strategies—A Consensus Statement from the European Atherosclerosis Society. European Heart Journal, 42, 4791-4806. https://doi.org/10.1093/eurheartj/ehab551 |
| [21] | Wang, X., Xu, W., Song, Q., Zhao, Z., Meng, X., Xia, C., et al. (2022) Association between the Triglyceride-Glucose Index and Severity of Coronary Artery Disease. Cardiovascular Diabetology, 21, Article No. 168. https://doi.org/10.1186/s12933-022-01606-5 |
| [22] | Park, K., Ahn, C.W., Lee, S.B., Kang, S., Nam, J.S., Lee, B.K., et al. (2019) Elevated Tyg Index Predicts Progression of Coronary Artery Calcification. Diabetes Care, 42, 1569-1573. https://doi.org/10.2337/dc18-1920 |
| [23] | Lee, E.Y., Yang, H.K., Lee, J., Kang, B., Yang, Y., Lee, S., et al. (2016) Triglyceride Glucose Index, a Marker of Insulin Resistance, Is Associated with Coronary Artery Stenosis in Asymptomatic Subjects with Type 2 Diabetes. Lipids in Health and Disease, 15, Article No. 155. https://doi.org/10.1186/s12944-016-0324-2 |
| [24] | Wang, W., Yang, J., Wang, K., Niu, J., Liu, Y. and Ge, H. (2024) Association between the Triglyceride-Glucose Index and In-Hospital Major Adverse Cardiovascular Events in Patients with Acute Coronary Syndrome: Results from the Improving Care for Cardiovascular Disease in China (CCC)-Acute Coronary Syndrome Project. Cardiovascular Diabetology, 23, Article No. 170. https://doi.org/10.1186/s12933-024-02270-7 |
| [25] | 刘正阳, 张月兰. 甘油三酯-葡萄糖指数对ACS患者冠状动脉病变严重程度及MACEs的预测价值[J]. 重庆医学, 2023, 52(8): 1141-1146. |
| [26] | Wang, M., Zhou, L., Su, W., Dang, W., Li, H. and Chen, H. (2023) Independent and Joint Associations between the Triglyceride-Glucose Index and NT-proBNP with the Risk of Adverse Cardiovascular Events in Patients with Diabetes and Acute Coronary Syndrome: A Prospective Cohort Study. Cardiovascular Diabetology, 22, Article No. 149. https://doi.org/10.1186/s12933-023-01890-9 |
| [27] | Chen, Q., Xiong, S., Zhang, Z., Yu, X., Chen, Y., Ye, T., et al. (2023) Triglyceride-Glucose Index Is Associated with Recurrent Revascularization in Patients with Type 2 Diabetes Mellitus after Percutaneous Coronary Intervention. Cardiovascular Diabetology, 22, Article No. 284. https://doi.org/10.1186/s12933-023-02011-2 |
| [28] | Zhao, Q., Zhang, T., Cheng, Y., Ma, Y., Xu, Y., Yang, J., et al. (2021) Triglyceride-Glucose Index as a Surrogate Marker of Insulin Resistance for Predicting Cardiovascular Outcomes in Nondiabetic Patients with Non-ST-Segment Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Journal of Atherosclerosis and Thrombosis, 28, 1175-1194. https://doi.org/10.5551/jat.59840 |
| [29] | Yang, J., Tang, Y., Zheng, Y., Li, C., Zhou, Q., Gao, J., et al. (2021) The Impact of the Triglyceride-Glucose Index on Poor Prognosis in Nondiabetic Patients Undergoing Percutaneous Coronary Intervention. Frontiers in Endocrinology, 12, Article ID: 710240. https://doi.org/10.3389/fendo.2021.710240 |
| [30] | Al Jumaily, T., Rose'Meyer, R.B., Sweeny, A. and Jayasinghe, R. (2015) Cardiac Damage Associated with Stress Hyperglycaemia and Acute Coronary Syndrome Changes According to Level of Presenting Blood Glucose. International Journal of Cardiology, 196, 16-21. https://doi.org/10.1016/j.ijcard.2015.05.143 |
| [31] | 贾宁, 王明生, 赵霞. 甘油三酯-葡萄糖指数对急性心肌梗死患者经皮冠状动脉介入治疗后长期预后的影响[J]. 重庆医科大学学报, 2023, 48(4): 417-422. |
| [32] | Liu, H., Wang, L., Wang, H., Hao, X., Du, Z., Li, C., et al. (2024) The Association of Triglyceride-Glucose Index with Major Adverse Cardiovascular and Cerebrovascular Events after Acute Myocardial Infarction: A Meta-Analysis of Cohort Studies. Nutrition & Diabetes, 14, Article No. 39. https://doi.org/10.1038/s41387-024-00295-1 |
| [33] | Ni, W., Jiang, R., Xu, D., Zhu, J., Chen, J., Lin, Y., et al. (2025) Association between Insulin Resistance Indices and Outcomes in Patients with Heart Failure with Preserved Ejection Fraction. Cardiovascular Diabetology, 24, Article No. 32. https://doi.org/10.1186/s12933-025-02595-x |
| [34] | Zhou, Y., Wang, C., Che, H., Cheng, L., Zhu, D., Rao, C., et al. (2023) Association between the Triglyceride-Glucose Index and the Risk of Mortality among Patients with Chronic Heart Failure: Results from a Retrospective Cohort Study in China. Cardiovascular Diabetology, 22, Article No. 171. https://doi.org/10.1186/s12933-023-01895-4 |
| [35] | Aroor, A.R., Mandavia, C.H. and Sowers, J.R. (2012) Insulin Resistance and Heart Failure: Molecular Mechanisms. Heart Failure Clinics, 8, 609-617. https://doi.org/10.1016/j.hfc.2012.06.005 |
| [36] | Dang, K., Wang, X., Hu, J., Zhang, Y., Cheng, L., Qi, X., et al. (2024) The Association between Triglyceride-Glucose Index and Its Combination with Obesity Indicators and Cardiovascular Disease: NHANES 2003-2018. Cardiovascular Diabetology, 23, Article No. 8. https://doi.org/10.1186/s12933-023-02115-9 |
| [37] | The Emerging Risk Factors Collaboration, (2011) Separate and Combined Associations of Body-Mass Index and Abdominal Adiposity with Cardiovascular Disease: Collaborative Analysis of 58 Prospective Studies. The Lancet, 377, 1085-1095. https://doi.org/10.1016/s0140-6736(11)60105-0 |
| [38] | Zhang, W., Liu, L., Chen, H., Li, S., Wan, M., Mohammed, A., et al. (2023) Association between the Triglyceride-Glucose Index and the Presence and Prognosis of Coronary Microvascular Dysfunction in Patients with Chronic Coronary Syndrome. Cardiovascular Diabetology, 22, Article No. 113. https://doi.org/10.1186/s12933-023-01846-z |
| [39] | Wang, K., Fan, T., He, F., Li, H., Fang, Y., Hu, G., et al. (2024) Influence of Sodium-Glucose Cotransporter 2 Inhibitors on the Triglyceride-Glucose Index in Acute Myocardial Infarction Patients with Type 2 Diabetes Mellitus. Cardiovascular Diagnosis and Therapy, 14, 1096-1107. https://doi.org/10.21037/cdt-24-287 |
