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TyG指数对糖尿病肾病患者进展至终末期肾脏病风险的预测价值
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Abstract:
目的：探讨甘油三酯–葡萄糖(TyG)指数对糖尿病肾脏病(DKD)患者终末期肾脏病(ESRD)风险的预测价值。方法：采用回顾性病例对照研究设计，选取2015年1月至2025年1月就诊于重庆医科大学附属永川医院内分泌科及肾病风湿科的糖尿病肾病(DKD)患者共206例，根据ESRD(即估计肾小球滤过率小于15 mL/min/1.73m2或开始透析或肾移植)状态，分为ESRD组102例和非ESRD组104例，统计各组病例性别、年龄、糖尿病病程、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、糖化血红蛋白(HbAlc)、肾功能、血脂及尿蛋白，计算TyG指数。采用多变量二元Logistic回归模型估计比值比(OR)和95%置信区间(CI)。研究TyG指数与DKD患者ESRD之间的关系，通过受试者操作特征曲线(ROC)评估计TyG指数及其联合模型(包含eGFR、尿蛋白)对DKD患者ESRD的预测效能。结果：ESRD组的基线TyG指数显著高于非ESRD组(9.57 ± 0.58 vs 9.12 ± 0.69, P < 0.05)。Logistic回归分析显示TyG指数是DKD患者ESRD风险的独立危险因素(未调整模型OR = 2.155，95%CI 1.546~3.005，P < 0.001；完全调整的模型：OR 2.100，95%CI 1.284~3.435, P = 0.003)。ROC曲线分析结果显示，TyG指数单独诊断ESRD的AUC为0.687 (95%CI: 0.616~0.759, P = 0.000)；TyG指数联合eGFR及尿蛋白的联合预测模型AUC为0.814 (95%CI: 0.757~0.872, P = 0.000)，两组比较差异具有统计学意义(Z = 2.58, P = 0.004)。结论：高的TyG指数与DKD患者ESRD风险增加相关，TyG可作为ESRD风险的简易筛查指标，联合常规肾功能指标可提升其预测效能。
Objective: To explore the predictive value of triglyceride-glucose (TyG) index for the risk of end-stage renal disease (ESRD) in patients with diabetic kidney disease (DKD). Methods: A retrospective case-control study was conducted. A total of 206 patients with diabetic kidney disease (DKD) admitted to the Department of Endocrinology and the Department of Nephrology and Rheumatology of Yongchuan Hospital Affiliated to Chongqing Medical University from January 2015 to January 2025 were enrolled. According to the status of ESRD (estimated glomerular filtration rate < 15 mL/min/1.73m2 or initiation of dialysis or renal transplantation), 102 cases were divided into ESRD group and 104 cases into non-ESRD group. The gender, age, duration of diabetes, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), glycosylated hemoglobin (HbAlc), renal function, blood lipid and urine protein were recorded, and TyG index was calculated. Multivariable binary Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI). The relationship between TyG index and ESRD in DKD patients was studied, and the receiver operating characteristic curve (ROC) was used to evaluate the predictive efficacy of TyG index and its combined model (including eGFR and urinary protein) for ESRD in DKD patients. Results: The baseline TyG index in ESRD group was significantly higher than that in non-ESRD group (9.57 ± 0.58 vs 9.12 ± 0.69, P < 0.05). Logistic regression analysis
| [1] | Ogurtsova, K., Guariguata, L., Barengo, N.C., Ruiz, P.L., Sacre, J.W., Karuranga, S., et al. (2022) IDF Diabetes Atlas: Global Estimates of Undiagnosed Diabetes in Adults for 2021. Diabetes Research and Clinical Practice, 183, Article ID: 109118. https://doi.org/10.1016/j.diabres.2021.109118 |
| [2] | Umanath, K. and Lewis, J.B. (2018) Update on Diabetic Nephropathy: Core Curriculum 2018. American Journal of Kidney Diseases, 71, 884-895. https://doi.org/10.1053/j.ajkd.2017.10.026 |
| [3] | González-Pérez, A., Saez, M., Vizcaya, D., Lind, M. and Garcia Rodriguez, L. (2021) Incidence and Risk Factors for Mortality and End-Stage Renal Disease in People with Type 2 Diabetes and Diabetic Kidney Disease: A Population-Based Cohort Study in the UK. BMJ Open Diabetes Research & Care, 9, e002146. https://doi.org/10.1136/bmjdrc-2021-002146 |
| [4] | Yun, C.J., Fai, W.E.Y., Hang, C.E.P., et al. (2017) The Health-Related Quality of Life of Chinese Patients on Hemodialysis and Peritoneal Dialysis. The Patient, 10, 799-808. |
| [5] | Chen, H., Kuo, S., Su, P., Wu, J. and Ou, H. (2020) Health Care Costs Associated with Macrovascular, Microvascular, and Metabolic Complications of Type 2 Diabetes across Time: Estimates from a Population-Based Cohort of More than 0.8 Million Individuals with up to 15 Years of Follow-up. Diabetes Care, 43, 1732-1740. https://doi.org/10.2337/dc20-0072 |
| [6] | Nakhaee, S., Azadi, R., Salehinia, H., Moodi, M., Zarban, A., Sharifi, F., et al. (2024) The Role of Nitric Oxide, Insulin Resistance, and Vitamin D in Cognitive Function of Older Adults. Scientific Reports, 14, Article No. 30020. https://doi.org/10.1038/s41598-024-81551-3 |
| [7] | Arnold, S.E., Arvanitakis, Z., Macauley-Rambach, S.L., Koenig, A.M., Wang, H., Ahima, R.S., et al. (2018) Brain Insulin Resistance in Type 2 Diabetes and Alzheimer Disease: Concepts and Conundrums. Nature Reviews Neurology, 14, 168-181. https://doi.org/10.1038/nrneurol.2017.185 |
| [8] | Hou, C., Yuan, X., Peng, M., Shi, X., Yang, D., Wang, F., et al. (2025) The Role of Insulin Resistance in the Longitudinal Progression from NAFLD to Cardiovascular-Kidney-Metabolic Disease. Cardiovascular Diabetology, 24, Article No. 398. https://doi.org/10.1186/s12933-025-02953-9 |
| [9] | Fortin, E., Campi, B., Ferrannini, E., Mari, A., Mellbin, L.G., Norhammar, A., et al. (2023) High Mannose Correlates with Surrogate Indexes of Insulin Resistance and Is Associated with an Increased Risk of Cardiovascular Events Independently of Glycemic Status and Traditional Risk Factors. Diabetes Care, 47, 246-251. https://doi.org/10.2337/dc23-0870 |
| [10] | Kim, B., Kim, G., Han, K., Maki, N., Taniguchi, K. and Oh, S. (2023) The Triglyceride-Glucose Index Is Independently Associated with Chronic Kidney Disease in the Geriatric Population, Regardless of Obesity and Sex. Annals of Geriatric Medicine and Research, 27, 258-265. https://doi.org/10.4235/agmr.23.0096 |
| [11] | Artunc, F., Schleicher, E., Weigert, C., Fritsche, A., Stefan, N. and Häring, H. (2016) The Impact of Insulin Resistance on the Kidney and Vasculature. Nature Reviews Nephrology, 12, 721-737. https://doi.org/10.1038/nrneph.2016.145 |
| [12] | Whaley-Connell, A. and Sowers, J.R. (2017) Insulin Resistance in Kidney Disease: Is There a Distinct Role Separate from That of Diabetes or Obesity. Cardiorenal Medicine, 8, 41-49. https://doi.org/10.1159/000479801 |
| [13] | Yusuf, S., Teo, K.K., Pogue, J., et al. (2008) Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events. The New England Journal of Medicine, 358, 1547-1559. |
| [14] | 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 |
| [15] | Aslan Çin, N.N., Yardımcı, H., Koç, N., Uçaktürk, S.A. and Akçil Ok, M. (2020) Triglycerides/High-Density Lipoprotein Cholesterol Is a Predictor Similar to the Triglyceride-Glucose Index for the Diagnosis of Metabolic Syndrome Using International Diabetes Federation Criteria of Insulin Resistance in Obese Adolescents: A Cross-Sectional Study. Journal of Pediatric Endocrinology and Metabolism, 33, 777-784. https://doi.org/10.1515/jpem-2019-0310 |
| [16] | Pradeepa, R., Jha, V., Thyparambil Aravindakshan, P., Waghdhare, S., Mohan, V., Chambers, J., et al. (2024) 1991-LB: Triglyceride-Glucose Index Is an Effective Tool for Assessing Glycemic Control in Asian Indians with Type 2 Diabetes. Diabetes, 73, 1991-LB. https://doi.org/10.2337/db24-1991-lb |
| [17] | Flake, C.C., Morales-Valenzuela, M., Tiongco, R.E. and Navarro, A. (2024) Profiling Triglyceride-Glucose Index in Filipinos with Type 2 Diabetes Mellitus: A Single-Center Study. The Egyptian Journal of Internal Medicine, 36, Article No. 27. https://doi.org/10.1186/s43162-024-00294-9 |
| [18] | Campos Muñiz, C., León-García, P.E., Serrato Diaz, A. and Hernández-Pérez, E. (2023) Diabetes Mellitus Prediction Based on the Triglyceride and Glucose Index. Medicina Clínica (English Edition), 160, 231-236. https://doi.org/10.1016/j.medcle.2023.03.001 |
| [19] | Mah jabeen, W., Jahangir, B., Khilji, S. and Aslam, A. (2023) Association of Triglyceride Glucose Index and Triglyceride HDL Ratio with Glucose Levels, Microvascular and Macrovascular Complications in Diabetes Mellitus Type-2. Pakistan Journal of Medical Sciences, 39, 1255-1259. https://doi.org/10.12669/pjms.39.5.7389 |
| [20] | Kassab, H.S., Osman, N.A. and Elrahmany, S.M. (2023) Assessment of Triglyceride–glucose Index and Ratio in Patients with Type 2 Diabetes and Their Relation to Microvascular Complications. Endocrine Research, 48, 94-100. https://doi.org/10.1080/07435800.2023.2245909 |
| [21] | Wang, H., Chen, G., Sun, D. and Ma, Y. (2024) The Threshold Effect of Triglyceride Glucose Index on Diabetic Kidney Disease Risk in Patients with Type 2 Diabetes: Unveiling a Non-Linear Association. Frontiers in Endocrinology, 15, Article 1411486. https://doi.org/10.3389/fendo.2024.1411486 |
| [22] | Low, S., Pek, S., Moh, A., Ang, K., Khoo, J., Shao, Y., et al. (2022) Triglyceride-Glucose Index Is Prospectively Associated with Chronic Kidney Disease Progression in Type 2 Diabetes—Mediation by Pigment Epithelium-Derived Factor. Diabetes and Vascular Disease Research, 19, 1-9. https://doi.org/10.1177/14791641221113784 |
| [23] | Fritz, J., Brozek, W., Concin, H., Nagel, G., Kerschbaum, J., Lhotta, K., et al. (2021) The Triglyceride-Glucose Index and Obesity-Related Risk of End-Stage Kidney Disease in Austrian Adults. JAMA Network Open, 4, e212612. https://doi.org/10.1001/jamanetworkopen.2021.2612 |
| [24] | Levey, A.S., Stevens, L.A., Schmid, C.H., Zhang, Y., Castro, A.F., Feldman, H.I., et al. (2009) A New Equation to Estimate Glomerular Filtration Rate. Annals of Internal Medicine, 150, 604-612. https://doi.org/10.7326/0003-4819-150-9-200905050-00006 |
| [25] | 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 |
| [26] | Trikudanathan, S., Raji, A., Chamarthi, B., Seely, E.W. and Simonson, D.C. (2013) Comparison of Insulin Sensitivity Measures in South Asians. Metabolism, 62, 1448-1454. https://doi.org/10.1016/j.metabol.2013.05.016 |
| [27] | Mohd Nor, N.S., Lee, S., Bacha, F., Tfayli, H. and Arslanian, S. (2015) Triglyceride Glucose Index as a Surrogate Measure of Insulin Sensitivity in Obese Adolescents with Normoglycemia, Prediabetes, and Type 2 Diabetes Mellitus: Comparison with the Hyperinsulinemic-Euglycemic Clamp. Pediatric Diabetes, 17, 458-465. https://doi.org/10.1111/pedi.12303 |
| [28] | Susmita, S. and Mainul, H. (2022) Insulin Resistance and Type 2 Diabetes Mellitus: An Ultimatum to Renal Physiology. Cureus, 14, e28944. |
| [29] | Mosterd, C.M., Kanbay, M., van den Born, B.J.H., van Raalte, D.H. and Rampanelli, E. (2021) Intestinal Microbiota and Diabetic Kidney Diseases: The Role of Microbiota and Derived Metabolites Inmodulation of Renal Inflammation and Disease Progression. Best Practice & Research Clinical Endocrinology & Metabolism, 35, Article ID: 101484. https://doi.org/10.1016/j.beem.2021.101484 |
| [30] | Pérez-Morales, R.E., del Pino, M.D., Valdivielso, J.M., Ortiz, A., Mora-Fernández, C. and Navarro-González, J.F. (2018) Inflammation in Diabetic Kidney Disease. Nephron, 143, 12-16. https://doi.org/10.1159/000493278 |
| [31] | Duni, A., Liakopoulos, V., Roumeliotis, S., Peschos, D. and Dounousi, E. (2019) Oxidative Stress in the Pathogenesis and Evolution of Chronic Kidney Disease: Untangling Ariadne’s Thread. International Journal of Molecular Sciences, 20, Article 3711. https://doi.org/10.3390/ijms20153711 |
| [32] | Tung, C., Hsu, Y., Shih, Y., Chang, P. and Lin, C. (2018) Glomerular Mesangial Cell and Podocyte Injuries in Diabetic Nephropathy. Nephrology, 23, 32-37. https://doi.org/10.1111/nep.13451 |
| [33] | Yilmaz, O. and Erinc, O. (2025) Evaluation of the Relationship between Albuminuria and Triglyceride Glucose Index in Patients with Type 2 Diabetes Mellitus: A Retrospective Cross-Sectional Study. Medicina, 61, Article 1803. https://doi.org/10.3390/medicina61101803 |
