慢性肾病患者甘油三酯葡萄糖体重指数与全因死亡率和心血管死亡率的关系-动脉网

Association of triglyceride-glucose-body mass index with all-cause and cardiovascular mortality among individuals with chronic kidney disease

Nature 等信源发布 2024-09-04 20:57

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AbstractThere is still a paucity of research on the relationship between triglyceride-glucose-body mass index (TyG-BMI) and long-term all-cause and cardiovascular disease (CVD) mortality in patients with chronic kidney disease (CKD). The objective of this study was to explore the relationship between the TyG-BMI index and mortality rate and to determine valuable predictive factors for the survival status of this population.

关于慢性肾脏病（CKD）患者甘油三酯-葡萄糖体重指数（TyG-BMI）与长期全因和心血管疾病（CVD）死亡率之间关系的研究仍然很少。本研究的目的是探讨TyG BMI指数与死亡率之间的关系，并确定该人群生存状况的有价值的预测因素。

Data were obtained from the National Health and Nutrition Examination Survey (NHANES 2001–2018) and the National Death Index (NDI). We used multivariate Cox regression and restricted cubic spline (RCS) to analyze the link between the TyG-BMI index and all-cause and CVD mortality. Subgroup analysis was conducted according to age, gender, race, education and poverty.

数据来自国家健康和营养检查调查（NHANES 2001-2018）和国家死亡指数（NDI）。我们使用多变量Cox回归和限制性三次样条（RCS）来分析TyG BMI指数与全因和CVD死亡率之间的联系。根据年龄，性别，种族，教育程度和贫困程度进行亚组分析。

In addition, receiver operating characteristic (ROC) curves were utilized to assess the differentiation of the TyG-BMI index in predicting mortality. A total of 3089 individuals were enrolled. Over a median follow-up period of 81 months, 1097 individuals passed away. The RCS analysis revealed a U-shaped link between the TyG-BMI index and all-cause and CVD mortality.

此外，受试者工作特征（ROC）曲线用于评估TyG BMI指数在预测死亡率方面的差异。共招募了3089人。在81个月的中位随访期内，1097人死亡。RCS分析显示，TyG BMI指数与全因和心血管疾病死亡率之间存在U形联系。

The ROC curve indicated that the TyG-BMI index has a stronger diagnostic effect than the TyG index. Subgroup analysis results demonstrated that the TyG-BMI index was more significantly correlated with all-cause and CVD mortality rates in elderly patients. In the American population, a U-shaped association was discovered between the baseline TyG-BMI index and all-cause and cardiovascular mortality rates in CKD patients.

ROC曲线表明，TyG BMI指数比TyG指数具有更强的诊断效果。亚组分析结果表明，TyG BMI指数与老年患者的全因死亡率和心血管疾病死亡率更显着相关。在美国人群中，基线TyG BMI指数与CKD患者的全因死亡率和心血管死亡率之间存在U型关联。

The thresholds for all-cause and CVD mortality were found to be 299.31 and 294.85, respectively..

全因死亡率和心血管疾病死亡率的阈值分别为299.31和294.85。。

IntroductionAs a serious health issue, chronic kidney disease (CKD) affects 15–20% of the global population. This condition poses a substantial threat to public health, presenting a formidable challenge for both the international community and healthcare systems worldwide1. Due to its irreversible progression, the burden of CKD rapidly increases, with CKD having the highest disability and mortality rates among chronic diseases2.

引言作为一个严重的健康问题，慢性肾病（CKD）影响全球15-20%的人口。这种情况对公共卫生构成了巨大威胁，对国际社会和全球医疗保健系统都提出了巨大挑战1。由于其不可逆转的进展，CKD的负担迅速增加，CKD在慢性疾病中具有最高的残疾率和死亡率2。

Identifying and intervening early on hazard factors that influence prognosis is essential for alleviating the global burden of cardiovascular disease (CVD) among CKD patients.Insulin resistance (IR) is a key characteristic of metabolic syndrome, marked by a decreased ability of insulin to effectively promote glucose utilization3.

早期识别和干预影响预后的危险因素对于减轻CKD患者心血管疾病（CVD）的全球负担至关重要。胰岛素抵抗（IR）是代谢综合征的一个关键特征，其特征是胰岛素有效促进葡萄糖利用的能力下降3。

IR is acknowledged as a hazard factor contributing to the development of macrovascular lesions4. Although the high insulin normal glucose clamp test is considered the gold standard for measuring insulin resistance (IR), it is a invasive procedure, making it unsuitable for clinical research5. A practical alternative evaluation metric is the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), which is derived from measurements of fasting blood glucose and insulin levels6.

IR被认为是导致大血管病变发展的危险因素4。虽然高胰岛素正常葡萄糖钳夹试验被认为是测量胰岛素抵抗（IR）的金标准，但它是一种侵入性程序，不适合临床研究5。一种实用的替代评估指标是胰岛素抵抗的稳态模型评估（HOMA-IR），它来自空腹血糖和胰岛素水平的测量6。

However, circulating insulin concentration is not conventionally measured in primary healthcare settings, prompting the development of various simple and feasible alternative indicators for evaluating insulin resistance (IR). Notable among these are the triglyceride glucose index (TyG-index) and the triglyceride glucose body mass index (TyG-BMI index)7,8.

然而，循环胰岛素浓度在初级保健环境中不是常规测量的，这促使开发各种简单可行的替代指标来评估胰岛素抵抗（IR）。其中值得注意的是甘油三酯葡萄糖指数（TyG指数）和甘油三酯葡萄糖体重指数（TyG BMI指数）7,8。

Several studies have displayed an link between the TyG index and the onset and progression of chronic kidney disease9,10. However, few studies have assessed the link between TyG-BMI and all-ca.

一些研究表明，TyG指数与慢性肾脏疾病的发生和发展之间存在联系9,10。然而，很少有研究评估TyG BMI与all-ca之间的联系。

Table 1 The characteristics of participants according to survival status.Full size tableStatistical analysisGiven the complex sampling design of NHANES, the analysis incorporated minimum sample weights. Participants were categorized into two groups based on their survival status to depict the characteristics of the study population.

表1参与者根据生存状态的特征。全尺寸表统计分析鉴于NHANES的复杂抽样设计，分析纳入了最小样本权重。参与者根据其生存状况分为两组，以描述研究人群的特征。

Continuous variables are represented by weighted means and standard error (SE), with hypothesis testing conducted using either the t-test or the Kruskal–Wallis rank sum test, depending on the distribution of the data. Categorical variables are represented by weighted proportions, and their differences between groups were tested using the chi-square test.

连续变量由加权平均值和标准误差（SE）表示，根据数据的分布，使用t检验或Kruskal-Wallis秩和检验进行假设检验。分类变量用加权比例表示，组间差异用卡方检验进行检验。

The multivariate Cox proportional hazards model was used to evaluate the relationship between the TyG-BMI index and survival status. The dependent variables were survival time and survival status. We constructed three regression models by adjusting for different covariates. In Model 1, no adjustments were made.

多变量Cox比例风险模型用于评估TyG BMI指数与生存状态之间的关系。因变量是生存时间和生存状态。我们通过调整不同的协变量构建了三个回归模型。在模型1中，没有进行任何调整。

Model 2 was adjusted for age, gender, race, education level, poverty status (PIR), and smoking status. Model 3 is a comprehensive adjustment model, which further adjusted for hypertension, diabetes, cardiovascular disease, blood lipids, uACR, and eGFR levels based on Model 2. We calculated the hazard ratio (HR) for each covariate and its 95% confidence interval to quantify the strength of the association between the TyG-BMI index and mortality.

模型2根据年龄，性别，种族，教育程度，贫困状况（PIR）和吸烟状况进行了调整。。我们计算了每个协变量的风险比（HR）及其95%置信区间，以量化TyG BMI指数与死亡率之间的关联强度。

Restricted Cubic Splines (RCS) analysis, a flexible nonlinear regression method, was employed to explore the nonlinear relationship between continuous variables and outcome variables. We selected three nodes (5th, 50th, and 95th percentiles) and constructed an RCS function to capture the nonlinear effects of the TyG-BMI index.

约束三次样条（RCS）分析是一种灵活的非线性回归方法，用于探索连续变量和结果变量之间的非线性关系。我们选择了三个节点（第5、50和95百分位数），并构建了一个RCS函数来捕捉TyG BMI指数的非线性效应。

The model with th.

具有th的模型。

Table 2 Relationship between TyG-BMI index and all-cause mortality.Full size tableTable 3 Relationship between TyG-BMI index and CVD mortality.Full size tableFig. 2The restricted cubic regression between TyG-BMI index with all-cause mortality (A) and cardiovascular mortality (B) in fully adjusted model.Full size imageFig.

表2 TyG BMI指数与全因死亡率之间的关系。全尺寸表表3 TyG BMI指数与CVD死亡率之间的关系。全尺寸表图。2在完全调整的模型中，TyG BMI指数与全因死亡率（A）和心血管死亡率（B）之间的限制性三次回归。全尺寸图像图。

3Restricted cubic splines (RCS) analysis of the TyG-BMI index and its association with all-cause mortality and cardiovascular mortality stratified by CKD stages. (A,B) Represent CKD stages I–II, while (C,D) represent CKD stages III–V.Full size imageSubgroup analysis resultsIn subgroup analyses, the association between the TyG-BMI index and all-cause and cardiovascular mortality was consistent across subgroups stratified by sex, race, education and poverty.

3限制性三次样条（RCS）分析TyG BMI指数及其与CKD分期分层的全因死亡率和心血管死亡率的关系。（A，B）代表CKD I-II期，而（C，D）代表CKD III-V期。全尺寸图像亚组分析结果在亚组分析中，TyG BMI指数与全因死亡率和心血管死亡率之间的关联在按性别，种族，教育程度和贫困分层的亚组中是一致的。

However, the correlation was more significant in elderly CKD patients for both all-cause and CVD mortality (Table 4)..

然而，老年CKD患者的全因死亡率和心血管疾病死亡率的相关性更为显着（表4）。。

Table 4 Result of subgroup analysis.Full size tableSensitivity and specificity analysisThe receiver operating characteristic (ROC) curve (Fig. 4) was utilized to access the sensitivity and specificity of the TyG-BMI index as a prognostic diagnostic tool. Compared to the TyG index alone, the TyG-BMI index demonstrated higher predictive ability for all-cause and cardiovascular mortality, with values of 0.578 and 0.550, respectively.

表4亚组分析结果。全尺寸表敏感性和特异性分析利用受试者工作特征（ROC）曲线（图4）来获得TyG BMI指数作为预后诊断工具的敏感性和特异性。与单独的TyG指数相比，TyG BMI指数对全因死亡率和心血管死亡率的预测能力更高，分别为0.578和0.550。

In addition, we determined the optimal cutoff point for TyG-BMI using the Youden index. As shown in Table 5, the optimal cutoff values for TyG-BMI in predicting all-cause mortality and cardiovascular disease (CVD) mortality in patients with chronic kidney disease are 272.57 and 280.34, respectively.Fig.

此外，我们使用Youden指数确定了TyG BMI的最佳截止点。如表5所示，TyG BMI预测慢性肾病患者全因死亡率和心血管疾病（CVD）死亡率的最佳临界值分别为272.57和280.34。图。

4ROC curves for different surrogates to predict all-cause mortality (A) and cardiovascular mortality (B).Full size imageTable 5 The efficacy of TyG-BMI in predicting all-cause mortality and CVD mortality.Full size tableDiscussionThis study aims to reveal how the combination of triglyceride-glucose index and body mass index (TyG-BMI) affects the mortality outcomes of this specific population of patients with chronic kidney disease.

4ROC曲线用于预测全因死亡率（A）和心血管死亡率（B）。全尺寸成像表5 TyG BMI在预测全因死亡率和CVD死亡率方面的功效。全尺寸表格讨论本研究旨在揭示甘油三酯-葡萄糖指数和体重指数（TyG-BMI）的组合如何影响这一特定人群慢性肾脏病患者的死亡率结果。

By employing multivariate Cox regression and RCS analysis, we identified the TyG-BMI index as a reliable predictor of both all-cause and CVD mortality risk in CKD patients. The analysis revealed a U-shaped association between the TyG-BMI index and mortality risk, indicating that both high and low TyG-BMI values are linked to an increased risk of mortality in this population.

通过采用多变量Cox回归和RCS分析，我们确定TyG BMI指数是CKD患者全因和CVD死亡风险的可靠预测指标。分析显示，TyG BMI指数与死亡风险之间呈U型关联，表明高和低TyG BMI值均与该人群死亡风险增加有关。

In addition, the results of subgroup analysis indicated that the association between the TyG-BMI index and all-cause mortality and cardiovascular mortality was consistent across subgroups defined by gender, race/ethnicity, poverty rate, and educat.

此外，亚组分析结果表明，TyG BMI指数与全因死亡率和心血管死亡率之间的关联在性别，种族/民族，贫困率和教育程度定义的亚组中是一致的。

Data availability

数据可用性

Data is provided within the manuscript or supplementary information files.

数据在手稿或补充信息文件中提供。

AbbreviationsTyG-BMI:

缩写：体重指数

Triglyceride-glucose-body mass

甘油三酯葡萄糖体重

CKD:

CKD公司：

Chronic kidney disease

慢性肾脏疾病

NDI:

NDI：

National death index

全国死亡指数

uACR:

uACR：

Urinary albumin to creatinine ratio

尿白蛋白与肌酐比值

eGFR:

eGFR：

Glomerular filtration rate

肾小球滤过率

TC:

技术委员会：

Cholesterol

胆固醇

IR:

红外光谱：

Insulin resistance

胰岛素抵抗

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Download referencesAcknowledgementsThe authors express sincere gratitude to the individual who generously shared the original dataset for this study.FundingThis work was supported by Jiangxi Provincial Natural Science Foundation (20232BAB216020 and 20232BAB206104).Author informationAuthor notesThese authors contributed equally: Tao Chen, Hao Wan and Yixing Luo.Authors and AffiliationsDepartment of Urology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, ChinaTao Chen, Hao Wan & Luyao ChenDepartment of Urology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, ChinaTao ChenDepartment of Gastroenterology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, ChinaYixing LuoDivision of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USALuyao ChenAuthorsTao ChenView author publicationsYou can also search for this author in.

下载参考文献致谢作者衷心感谢慷慨分享本研究原始数据集的个人。资助这项工作得到了江西省自然科学基金（20232BAB216020和20232BAB206104）的支持。作者信息作者注意到这些作者做出了同样的贡献：陶晨，郝万和罗宜兴。作者和附属机构南昌大学江西医学院第一附属医院泌尿外科，南昌，中国陈涛，郝万和陈璐瑶，南昌大学江西医学院第二附属医院泌尿外科，南昌，中国陈涛江西医学院第一附属医院消化内科，南昌大学，南昌，中国宜兴罗湖美国明尼苏达州罗切斯特梅奥诊所肾脏病与高血压科陈璐瑶作者陈涛观点作者出版物您也可以在中搜索这位作者。

PubMed Google ScholarHao WanView author publicationsYou can also search for this author in

PubMed Google ScholarHao WanView作者出版物您也可以在

PubMed Google ScholarYixing LuoView author publicationsYou can also search for this author in

PubMed Google ScholarYixing LuoView作者出版物您也可以在

PubMed Google ScholarLuyao ChenView author publicationsYou can also search for this author in

PubMed Google ScholarLuyao ChenView作者出版物您也可以在

PubMed Google ScholarContributionsTC, CLY and HW wrote the main manuscript text and LYX prepared Figs. 1, 2 and 3. All authors reviewed the manuscript.Corresponding authorCorrespondence to

PubMed Google ScholarContributionsTC，CLY和HW撰写了主要手稿文本，LYX准备了图1、2和3。所有作者都审阅了手稿。对应作者对应

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Reprints and permissionsAbout this articleCite this articleChen, T., Wan, H., Luo, Y. et al. Association of triglyceride-glucose-body mass index with all-cause and cardiovascular mortality among individuals with chronic kidney disease.

转载和许可本文引用本文Chen，T.，Wan，H.，Luo，Y。等人。甘油三酯-葡萄糖体重指数与慢性肾脏病患者全因死亡率和心血管死亡率的关系。

Sci Rep 14, 20593 (2024). https://doi.org/10.1038/s41598-024-71579-wDownload citationReceived: 18 June 2024Accepted: 29 August 2024Published: 04 September 2024DOI: https://doi.org/10.1038/s41598-024-71579-wShare this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

Sci Rep 1420593（2024）。https://doi.org/10.1038/s41598-024-71579-wDownload引文接收日期：2024年6月18日接受日期：2024年8月29日发布日期：2024年9月4日OI：https://doi.org/10.1038/s41598-024-71579-wShare本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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KeywordsChronic kidney diseaseTyG-BMI indexAll-cause mortalityCardiovascular mortality

关键词慢性肾脏病BMI指数会导致死亡率心血管死亡率

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