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中华眼科医学杂志(电子版) ›› 2021, Vol. 11 ›› Issue (05) : 262 -267. doi: 10.3877/cma.j.issn.2095-2007.2021.05.002

论著

视网膜动脉硬化分级与甘油三酯葡萄糖乘积指数相关性的临床研究
佘海澄1, 严棽棽1, 孙蓬飞2, 姜一梦2, 范芳芳3, 贾佳3, 张岩3,†()   
  1. 1. 100730　首都医科大学附属北京同仁医院　北京同仁眼科中心　北京市眼科研究所　北京市眼科学与视觉科学重点实验室
    2. 100034　北京大学第一医院心内科
    3. 100034　北京大学第一医院心内科；100034　北京大学第一医院心血管疾病研究所
  • 收稿日期:2021-07-04 出版日期:2021-10-28
  • 通信作者: 张岩
  • 基金资助:
    首都卫生发展科研专项基金项目(首发2020-2-2053); 北京大学医学部-密歇根大学医学院转化医学与临床研究联合研究所和中央高校基本科研项目(BMU20110177、BMU20160530); 国家重点研发计划基金项目(2017YFC1307704); 中国心血管健康联盟进阶基金项目(2019-CCA-ACCEESS-112); 首都医科大学附属北京同仁医院青年人才培养计划种子基金项目(2018-YJJ-ZZL-031)

The relationship between triglyceride glucose index and retinal arteriosclerosis grading in a community-based population

Haicheng She1, Shenshen Yan1, Pengfei Sun2, Yimeng Jiang2, Fangfang Fan3, Jia Jia3, Yan Zhang3,†()   

  1. 1. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab., Beijing 100730, China
    2. Department of Cardiology, Peking University First Hospital, Beijing 100034, China
    3. Department of Cardiology, Peking University First Hospital, Beijing 100034, China; Institute of Cardiovascular Disease, Peking University First Hospital, Beijing 100034, China
  • Received:2021-07-04 Published:2021-10-28
  • Corresponding author: Yan Zhang
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引用本文：

佘海澄, 严棽棽, 孙蓬飞, 姜一梦, 范芳芳, 贾佳, 张岩. 视网膜动脉硬化分级与甘油三酯葡萄糖乘积指数相关性的临床研究[J]. 中华眼科医学杂志(电子版), 2021, 11(05): 262-267.

Haicheng She, Shenshen Yan, Pengfei Sun, Yimeng Jiang, Fangfang Fan, Jia Jia, Yan Zhang. The relationship between triglyceride glucose index and retinal arteriosclerosis grading in a community-based population[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2021, 11(05): 262-267.

目的

探讨视网膜动脉硬化分级与甘油三酯葡萄糖乘积指数(TyG)的相关性。

方法

选取"北京市石景山区社区动脉粥样硬化队列"中完成2019年12月至2020年1月随访，并具有完整彩色眼底照及TyG数据的764例患者为研究对象。其中，男性301例，女性463例。年龄33~86岁，平均年龄(62.3±7.3)岁。对所有患者以问卷调查采集一般信息，测量血压、身高、体重并计算体质指数(BMI)，测定空腹血糖、口服葡萄糖耐量试验2 h血糖、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及血肌酐，计算肾小球滤过率(eGFR)及TyG指数，采集彩色眼底图像。依据Scheie原则对视网膜动脉硬化进行分级。按照TyG指数<9.272和≥9.272将全部患者分为两组。年龄、BMI、收缩压、血糖、HDL-C、LDL-C及eGFR以±s进行描述，并采用独立样本t检验比较组间差异；吸烟状况、合并疾病及用药情况采用频数和百分比描述，以χ2检验比较组间差异。采用多因素Logistic回归分析TyG指数与视网膜动脉硬化分级的相关性，调整因素包括性别、年龄、BMI、吸烟状态、SBP、HLD-C、LDL-C、eGFR、自述心血管疾病史、服用降脂药物、服用降糖药物及服用降压药。使用广义相加模型进行视网膜动脉硬化分级与TyG指数平滑曲线拟合。

结果

在764例患者中，合并高血压、脂代谢紊乱和糖尿病者分别为416例、598例和247例，分别占54.5%、78.3%和32.3%；现在吸烟者129例，占16.9%；空腹血糖为(6.4±1.9)mmol/L；TyG指数为8.9±0.6。与TyG<9.272组相比，TyG≥9.272组患者的BMI、收缩压、LDL-C及空腹血糖水平较高，其差异具有统计学意义(t＝-3.855，-3.345，-5.928，-15.768；P<0.05)；HDL-C水平较低，其差异具有统计学意义(t＝7.266，P<0.05)；合并高血压、脂代谢紊乱和糖尿病的比例较高，其差异具有统计学意义(χ2＝6.333，57.723，119.71；P<0.05)。视网膜动脉硬化分级(0~1级与2~4级比较)与TyG指数呈正相关且检验具有统计学意义(r＝0.11, P<0.05)。经多因素回归分析，TyG指数每升高1，3~4级较0~1级视网膜动脉硬化患病比例增加59%，其相关性具有统计学意义(OR＝1.59，95%CI：1.02~2.49，P<0.05)。与TyG<9.3组相比，TyG≥9.3组患者视网膜动脉硬化3~4级较0~1级患病比例增加1.83倍，其相关性具有统计学意义(OR＝2.83，95%CI：1.31~6.11，P<0.05)。

结论

高TyG指数与3~4级重度视网膜动脉硬化相关。

关键词: 甘油三酯葡萄糖乘积指数, 甘油三酯, 空腹血糖, 视网膜动脉硬化
Objective

To investigate the relationship between triglyceride glucose index (TyG) and retinal arteriosclerosis grading in a community-based population.

Methods

764 subjects with fundus photograph and TyG data were included from December 2019 to January 2021 from an atherosclerosis cohort of Peking University First Hospital in Shijingshan District, Beijing. There were 301 male and 463 female with an average of (62.3±7.3) years-old (ranging from 33 to 86 years-old). General information was collected by questionnaire, blood pressure, height, weight, body mass index (BMI), fasting blood glucose, triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and creatinine were measured. Glomerular filtration rate (eGFR) and TyG index were calculated. Color fundus images were collected, and retinal arteriosclerosis was graded by experienced ophthalmologist according to Scheie′s classification. Subjects were divided into two groups according to TyG index (<9.272 and ≥9.272). Age, BMI, systolic blood pressure, blood glucose, HDL-C, LDL-C and eGFR were described by ±s, and t test was used to compare the differences between groups. Smoking status, concomitant diseases and medication were described by frequency and percentage, and Chi-square test was used to compare differences between groups. Multivariate logistic regression was used to analyze the correlation between TyG index and retinal arteriosclerosis grading, adjusted for factors including gender, age, BMI, smoking status, systolic blood pressure, HLD-C, LDL-C, eGFR, cardiovascular diseases history, use of lipid-lowering drugs, hypoglycemic drugs and antihypertensive drugs. The generalized additive model was used to fit the grading of retinal arteriosclerosis and the smooth curve of TYG index.

Results

Among of 764 subjects, 416 (54.5%), 598 (78.3%) and 247 (32.3%) had hypertension, dyslipidemia and diabetes mellitus, respectively. 129 (16.9%) were current smokers, the fasting blood glucose were (6.4±1.9)mmol/L, and the TyG index was 8.9±0.6. Compared with subjects with TyG<9.272, subjects with TyG≥9.272 had higher BMI, systolic blood pressure, LDL-C, fasting blood glucose, lower levels of HDL-C, a higher fasting blood glucose, and lower HDL-C with the significant difference (t=-3.855, -3.345, -5.928, -15.768, 7.266; P<0.05); hypertension, dyslipidemia and diabetes mellitus with the significant difference (χ2=6.333, 57.723, 119.71; P<0.05). The retinal arteriosclerosis grade (0—1 and 2—4) had the positive correlation with TyG index (r=0.11, P<0.05). Multivariate logistic regression analysis showed that retinal arteriosclerosis grade 3—4 increased 59% compared to grade 0—1 for every 1 increase of TyG (OR=1.59, 95%CI: 1.02 to 2.49, P<0.05). Compared with TyG groups (TyG<9.3), the incidence of retinal arteriosclerosis grade 3—4 increased by 183% (TyG≥9.3) (OR=2.83, 95%CI: 1.31 to 6.11, P<0.05).

Conclusions

High TyG index is associated with grade 3—4 severe retinal arteriosclerosis.

Key words: Triglyceride glucose index, Triglyceride, Fasting blood-glucose, Retinal arteriosclerosis
表1 研究对象基本特征的比较
组别 例数 年龄(±s，岁) 女性[例(%)] BMI(±s，kg/m2) 收缩压(±s，mmHg) TG (mmol/L) TC (mmol/L)
总体 764 62.3±7.3 463(60.6) 26.2±3.5 132.1±17.9 1.4 [1.0, 2.0] 5.2 (1.1)
TyG<9.272 573 62.5±7.4 356(62.1) 25.9±3.6 130.9±17.7 1.2 [0.9, 1.6] 5.1 (1.0)
TyG≥9.272 191 61.7±7.1 107(56.0) 27.0±3.1 135.9±18.2 2.6 [2.2, 3.4] 5.7 (1.2)
t/χ2值   1.243# 2.239* -3.855# -3.345# 349.35* -7.199*
P值   >0.05 >0.05 <0.05 <0.05 <0.05 <0.05
组别 例数 HDL-C(±s，mmol/L) LDL-C(±s，mmol/L) GLU(±s，mmol/L) eGFR(±s，mL/min/1.73 m2) 从不吸烟[例(%)] 曾经吸烟[例(%)] 现在吸烟[例(%)]
总体 764 1.4±0.3 3.2±0.8 6.4±1.9 94.7±11.6 578(75.8) 56(7.3) 129(16.9)
TyG<9.272 573 1.5±0.3 3.1±0.8 5.8±1.1 94.5±11.5 442(77.3) 42(7.3) 88(15.4)
TyG≥9.272 191 1.3±0.3 3.5±0.8 8.0±2.8 95.3±11.9 136(71.2) 14(7.3) 41(21.5)
t/χ2值   7.266# -5.928# -15.768# -0.821#   3.828**  
P值   <0.05 <0.05 <0.05 >0.05   >0.05  
组别 例数 合并高血压[例(%)] 合并脂代谢紊乱[例(%)] 合并糖尿病[例(%)] 合并心血管疾病[例(%)] 服用降糖药[例(%)] 服用降脂药[例(%)] 服用降压药[例(%)]
总体 764 416(54.5) 598(78.3) 247(32.3) 88 (11.5) 151(19.8) 146(19.1) 265(34.7)
TyG<9.272 573 297(51.8) 411(71.7) 124(21.6) 64 (11.2) 74(12.9) 96(16.8) 181(31.6)
TyG≥9.272 191 119(62.3) 187(97.9) 123(64.4) 24 (12.6) 77(40.3) 50(26.2) 84(44.0)
t/χ2值   6.333* 57.723* 119.71* 0.266* 67.608* 8.168* 9.612*
P值   <0.05 <0.05 <0.05 >0.05 <0.05 <0.05 <0.05
图1 视网膜动脉硬化分级与甘油三酯葡萄糖乘积指数的平滑曲线图
表2 Logistic回归分析视网膜动脉硬化分级(0~1级与2级比较及0~1级与3~4级比较)与甘油三酯葡萄糖乘积指数的相关性[例(%)]
视网膜动脉硬化分级 例数与占比 TyG每升高1 LnTyG每升高0.1 TyG四等分组<8.5 TyG四等分组8.5~8.8
0~1级 423(55.4) 423(55.4) 423(55.4) 121(63.4) 107(56.0)
2级 292(38.2) 292(38.2) 292(38.2) 60(31.4) 73(38.2)
3~4级 49(6.4) 49(6.4) 49(6.4) 10(5.2) 11(5.8)
OR (95%CI) 2级与0~1级单因素分析   1.43(1.12，1.81) 1.39(1.12，1.73) 参考 1.38(0.90，2.11)
P2级与0~1级单因素分析   <0.05 <0.05 参考 >0.05
OR (95%CI)3~4级与0~1级单因素分析   1.69(1.08，2.62) 1.61(1.07，2.44) 参考 1.24(0.51，3.04)
P3-4级与0~1级单因素分析   <0.05 <0.05 参考 >0.05
OR (95%CI)2级与0~1级多因素分析   1.24(0.93，1.66) 1.23(0.94，1.60) 参考 1.23(0.77，1.95)
P2级与0~1级多因素分析   >0.05 >0.05 参考 >0.05
OR (95%CI)3~4级与0~1级多因素分析   1.57(1.00，2.47) 1.50(1.18，1.89) 参考 0.83(0.30，2.30)
P3~4级与0~1级多因素分析   <0.05 <0.05 参考 >0.05
视网膜动脉硬化分级 例数与占比 TyG四等分组8.8~9.3 TyG四等分组≥9.3 TyG<9.3 TyG≥9.3
0~1级 423(55.4) 107(56.0) 88(46.1) 335(58.5) 88(46.1)
2级 292(38.2) 76(39.8) 83(43.5) 209(36.5) 83(43.5)
3~4级 49(6.4) 8(4.2) 20(10.5) 29(5.1) 20(10.5)
OR (95%CI) 2级与0~1级单因素分析   1.43(0.93，2.20) 1.90(1.24，2.93) 参考 1.51(1.07，2.14)
P2级与0~1级单因素分析   >0.05 <0.05 参考 <0.05
OR (95%CI)3~4级与0~1级单因素分析   0.90(0.34，2.38) 2.75(1.23，6.16) 参考 2.63(1.42，4.86)
P3-4级与0~1级单因素分析   >0.05 <0.05 参考 <0.05
OR (95%CI)2级与0~1级多因素分析   1.22(0.76，1.97) 1.53(0.90，2.60) 参考 1.29(0.86，1.92)
P2级与0~1级多因素分析   >0.05 >0.05 参考 >0.05
OR (95%CI)3~4级与0~1级多因素分析   0.69(0.24，2.02) 2.24(0.78，6.48) 参考 2.80(1.29，6.08)
P3~4级与0~1级多因素分析   >0.05 >0.05 参考 <0.05
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