老年人甘油三酯-葡萄糖指数与脑小血管病影像学标志物的关系

doi:10.3969/j.issn.1003-9198.2023.01.013

摘要/Abstract

摘要： 目的探讨老年人甘油三酯-葡萄糖指数(triglyceride-glucose index,TyG指数)与脑小血管病(cerebral small-vessel disease,CSVD)影像学标志物的关系。方法回顾性连续纳入2016~2018年江苏省人民医院老年医学科297例非卒中老年病人。使用核磁共振评估病人CSVD情况,收集病人人口学和各项临床数据。计算TyG指数,采用四分位法将所有病人按照TyG指数分为4组(Q1＜6.7796,Q2:6.7796~7.0584,Q3: 7.0585~7.4191,Q4＞7.4191),采用二元Logistic回归分析TyG指数与CSVD单个影像学标志物的相关性,采用有序回归分析TyG指数与CSVD总负担的关系。结果在TyG指数四分组中,Q4组脑室旁白质高信号(P-WMH)发生率和CSVD总负担明显升高,差异有统计学意义(P＜0.05)。校正年龄、性别、高血压、高血脂、糖尿病、房颤、吸烟史、饮酒史、收缩压、LDL-C、TC后,TyG指数每增加1个标准差,P-WMH风险增加0.539倍(95%CI: 1.106~2.142,P=0.025)。多因素二元Logistic回归分析发现,Q4组发生P-WMH的风险是Q1组2.848倍(95%CI: 1.201~6.752,P=0.018);多因素有序回归发现,Q4组发生CSVD总负担增加风险是Q1组的2.164倍(95%CI:1.130~4.150,P=0.020)。结论 TyG指数是P-WMH及严重CSVD总负担的独立危险因素。

关键词: 甘油三酯-葡萄糖指数, 脑小血管病, 老年人

Abstract: Objective To investigate the association between triglyceride-glucose(TyG)index and MRI parameters of cerebral small vessel disease(CSVD)in the elderly. Methods A total of 297 consecutive non-stroke patients in Department Geriatrics, Jiangsu Province Hospital from 2016 to 2018 were retrospectively enrolled. The demographic and clinical data were collected. TyG index was calculated and all patients were divided into 4 groups according to TyG index (Q1＜6.7796,Q2:6.7796-7.0584,Q3: 7.0585-7.4191,Q4＞7.4191) by quartile method. The correlation between TyG index and MRI parameters of CSVD was analyzed by binary Logistic regression, and the relationship between TyG index and the total burden of CSVD was analyzed by ordered regression. Results The incidence of paraventricular white matter hyper-density (P-WMH) and severe CSVD total burden were significantly higher in group Q4 than those in the other groups (P<0.05). The risk of P-WMH increased by 0.539 (95%CI: 1.106-2.142, P=0.025) if TyG index was increased by one standard deviation after adjusting the confounding factors. Binary Logistic regression analysis showed that the risk of P-WMH in group Q4 was 2.848 folds of that in group Q1 (95%CI: 1.201-6.752, P=0.018). Ordinal regression showed that the risk of increase of CSVD total burden in group Q4 was 2.164 (95%CI: 1.130-4.150, P= 0.020) folds of that in group Q1. Conclusions TyG Index is an independent risk factor for P-WMH and severe CSVD burden.

Key words: triglyceride-glucose index, cerebral small vessel disease, aged

中图分类号:

R 743

窦苗苗, 岑颜, 隗倩, 程曦, 陆小伟. 老年人甘油三酯-葡萄糖指数与脑小血管病影像学标志物的关系[J]. 实用老年医学, 2023, 37(1): 51-55.

DOU Miao-miao, CENG Yan, WEI Qian, CHENG Xi, LU Xiao-wei. Association between the triglyceride-glucose index and MRI parameters of cerebral small vessel disease in the elderly[J]. Practical Geriatrics, 2023, 37(1): 51-55.

参考文献

[1] 中国研究型医院学会脑小血管病专业委员会《中国脑小血管病诊治专家共识2021》编写组. 中国脑小血管病诊治专家共识2021[J].中国卒中杂志,2021,16(7): 716-726.
[2] QIAN L, YANG Y, CESAR R, et al. Cerebral small vessel disease[J]. Cell Transplant,2018,27(12): 1711-1722.
[3] OKAMURA T, HASHIMOTO Y, HAMAGUCHI M, et al. Triglyceride-glucose index(TyG index) is a predictor of incident colorectal cancer: a population-based longitudinal study[J]. BMC Endocr Disord,2020,20(1): 113.
[4] YANG X, ZHANG S, DONG Z, et al. Insulin resistance is a risk factor for overall cerebral small vessel disease burden in old nondiabetic healthy adult population[J]. Front Aging Neurosci,2019,11: 127.
[5] 郭啸鸣,陆珍辉,曹志勇,等. 甘油三酯-葡萄糖指数与60岁及以上脑小血管病患者血管性认知障碍的相关性分析[J]. 中华全科医师杂志,2021,20(9): 984-989.
[6] WARDLAW J M, SMITH E E, BIESSELS G J, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration[J]. Lancet Neurol,2013,12(8): 822-838.
[7] 方波,程燕,钟平. 血清血脂和胆红素水平与脑白质病变的相关性研究[J]. 临床神经病学杂志,2020,33(3): 186-190.
[8] LOES C A R, NATALIA S R. Emerging insights from the genetics of cerebral small-vessel disease[J]. Ann N Y Acad Sci,2020,1471(1): 5-17.
[9] LONGLONG H, HUIHUI B, XIAO H, et al. Relationship between the triglyceride glucose index and the risk of first stroke in elderly hypertensive patients[J]. Int J Gen Med,2022,15: 1271-1279.
[10] MICHELLE C J,REBECCA F G, BRIAN G K, et al. Association of coronary artery atherosclerosis with brain white matter hyperintensity[J]. Stroke,2021,52(8): 2594-2600.
[11] ALESSANDRA D S, ANA P S C, HELEN H M H, et al. Triglyceride-glucose index is associated with symptomatic coronary artery disease in patients in secondary care[J]. Cardiovasc Diabetol,2019,18(1): 89.
[12] 包鑫,卢昌宏,赵嫄,等. 三酰甘油葡萄糖指数与冠状动脉及颈动脉粥样硬化的相关性研究[J]. 中国全科医学,2022,25(15): 1845-1849.
[13] THOMAS T V S, ATHANASE D P, RONALD M A H, et al. Association between arterial stiffness, cerebral small vessel disease and cognitive impairment: a systematic review and meta-analysis[J]. Neurosci Biobehav Rev,2015,53: 121-130.
[14] 严梦雨,蔡颖源,陈郑宇,等. 颈动脉粥样硬化与脑小血管病的关系研究[J]. 实用老年医学,2020,34(12): 1289-1291.
[15] GARY F M. Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage[J]. J Appl Physiol(1985),2008,105(5): 1652-1660.