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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (3): 430-435. doi: 10.19723/j.issn.1671-167X.2025.03.004

• 论著 • 上一篇    下一篇

基于社区人群队列的甘油三酯-葡萄糖指数与心血管病发病和死亡的关联

陆梦溪1, 刘秋萍1, 周恬静1, 刘晓非1, 孙烨祥2, 沈鹏2, 林鸿波2, 唐迅1,3,*(), 高培1,3,4,*()   

  1. 1. 北京大学公共卫生学院流行病与卫生统计学系, 北京 100191
    2. 宁波市鄞州区疾病预防控制中心, 浙江宁波 315101
    3. 重大疾病流行病学教育部重点实验室(北京大学), 北京 100191
    4. 北京大学临床研究所真实世界证据评价中心, 北京 100191
  • 收稿日期:2025-02-07 出版日期:2025-06-18 发布日期:2025-06-13
  • 通讯作者: 唐迅, 高培
  • 基金资助:
    国家科技创新2030四大慢病重大专项(2024ZD0527406); 国家自然科学基金(82373662); 北京市自然科学基金(IS24047)

Association of triglyceride-glucose index and cardiovascular disease in a community-based Chinese cohort

Mengxi LU1, Qiuping LIU1, Tianjing ZHOU1, Xiaofei LIU1, Yexiang SUN2, Peng SHEN2, Hongbo LIN2, Xun TANG1,3,*(), Pei GAO1,3,4,*()   

  1. 1. Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
    2. Yinzhou District Center for Disease Control and Prevention, Ningbo 315101, Zhejiang, China
    3. Key Laboratory of Epidemiology of Major Disease (Peking University), Ministry of Education, Beijing 100191, China
    4. Center for Real-World Evidence Evaluation, Peking University Clinical Research Institute, Beijing 100191, China
  • Received:2025-02-07 Online:2025-06-18 Published:2025-06-13
  • Contact: Xun TANG, Pei GAO
  • Supported by:
    the Noncommunicable Chronic Diseases-National Science and Technology Major Project(2024ZD0527406); the National Natural Sciences Foundation of China(82373662); the Beijing Natural Science Foundation(IS24047)

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摘要：

目的: 在大样本社区人群队列中探索甘油三酯-葡萄糖(triglyceride-glucose, TyG)指数与心血管病发病和死亡的关联。方法: 研究对象为2010年1月1日至2020年5月31日纳入中国鄞州电子健康档案研究(CHinese Electronic health Records Research in Yinzhou, CHERRY)队列中40~79岁基线无心血管病史的人群。根据个体的基线甘油三酯和血糖水平计算TyG指数，采用Cox比例风险模型分析TyG指数与心血管病发病和死亡的关联，调整年龄、性别、教育水平、居住地、吸烟状态、体重指数、收缩压及总胆固醇等影响因素后计算风险比(hazard ratio, HR)及其95%置信区间(confidence interval, CI)。采用限制性立方样条回归方法进一步分析TyG指数与心血管病发病和死亡的非线性关联，并按性别、年龄分层探索其关联在不同亚组的差异。结果: 共纳入226 406名研究对象，人群的基线平均年龄为(55.0±9.7)岁，46.8%为男性，TyG指数的中位数为8.68。在中位随访7.99年期间，9 815人(4.34%)出现心血管病发病和死亡。调整年龄、性别、教育水平、居住地、吸烟状态、体重指数、收缩压及总胆固醇等影响因素后，心血管病发病和死亡的风险呈现随TyG指数增加而增大的趋势(P < 0.001)，TyG指数处于上四分位数(TyG>9.10)组与下四分位数组(TyG≤8.32)相比，心血管病发病和死亡的风险增加42%(HR=1.42，95%CI：1.34~1.51)。TyG指数对于60岁以下低年龄组人群的心血管病发病和死亡风险增加的效应值相比60岁及以上人群更明显(HR：1.71 vs. 1.27，P < 0.05)。限制性立方样条回归的结果进一步显示，在总人群中TyG指数与心血管病发病和死亡的关联呈现“反L型”关系(非线性趋势P < 0.001)，TyG指数超过8.67阈值时心血管病发病和死亡的风险随该指数的增加而升高；但这种非线性关联的风险阈值存在性别差异，女性(8.51)低于男性(8.67)。结论: TyG指数与心血管病发病和死亡存在明显阈值效应的非线性关系，当TyG指数超过一定阈值时，心血管病发病和死亡发生的风险增加，且女性的阈值低于男性，提示后续利用TyG指数开展综合风险预测与危险因素干预时，需要按性别分层管理，特别是在60岁以下人群中开展早期干预具有重要的公共卫生学意义。

关键词: 心血管病, 危险因素, 甘油三酯-葡萄糖指数, 队列研究

Abstract:

Objective: To investigate the association between the triglyceride-glucose (TyG) index and the incidence and mortality of cardiovascular disease (CVD) in a large population-based cohort. Methods: Participants aged 40-79 years without a history of CVD at baseline were drawn from the CHinese Electronic health Records Research in Yinzhou (CHERRY) study between January 1, 2010, and May 31, 2020. The TyG index was calculated using baseline triglyceride and fasting blood glucose. Cox proportional hazards models were used to assess the association between the TyG index and the composite outcome of CVD (incidence and mortality), adjusting for age, gender, education, region, smoking status, body mass index, systolic blood pressure, and total cholesterol. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Nonlinear associations between the TyG index and CVD were further evaluated using restricted cubic splines, and subgroup analyses by gender and age were conducted to explore potential differences. Results: A total of 226 406 individuals were included, with a mean age of (55.0±9.7) years at baseline, 46.8% of whom were men, and a median TyG index of 8.68. Over a median follow-up of 7.99 years, 9 815 (4.34%) participants experienced CVD incidence or mortality. After adjusting for age, gender, education, region, smoking status, body mass index, systolic blood pressure and total cholesterol, the risk of CVD increased with higher TyG index levels (P < 0.001). The risk in the highest TyG quartile (TyG>9.10) was 42% higher than in the lowest quartile (TyG≤8.32) (HR=1.42, 95%CI: 1.34-1.51). Individuals under 60 years had a higher HR for CVD compared with those aged 60 years and above (HR: 1.71 vs. 1.27, P < 0.05). Restricted cubic spline analysis revealed a reverse L-shaped association between the TyG index and CVD risk in the overall population (P < 0.001 for nonlinear trend), with risk increasing after the TyG index exceeded 8.67. However, the threshold varied by gender, with a lower threshold in women (8.51) than in men (8.67). Conclusion: A significant nonlinear relationship was revealed between the TyG index and CVD risk, with a threshold effect. The risk of CVD increased once the TyG index surpassed a certain threshold, with a lower threshold in women than in men. These findings suggest that cardiovascular risk prediction and interventions based on the TyG index should be gender-stratified, and early intervention for individuals under 60 years old might have important public health implications.

Key words: Cardiovascular disease, Risk factors, Triglyceride-glucose index, Cohort study

中图分类号: 

  • R54

表1

研究对象的基线特征"

Characteristic Total (n=226 406) Women (n=120 558) Men (n=105 848) P value*
Age/years 55.0±9.7 54.5±9.6 55.5±9.9 < 0.001
Education (senior high school or higher) 34 173 (15.1) 14 806 (12.3) 40 238 (38.0) < 0.001
Region (Urban) 154 444 (68.2) 81 099 (67.3) 73 345 (69.3) < 0.001
Current smoker 41 861 (18.5) 1 623 (1.3) 40 238 (38.0) < 0.001
Diabetes 19 701 (8.7) 10 475 (8.7) 9 226 (8.7) 0.823
Hypertension 74 319 (32.8) 39 305 (32.6) 35 014 (33.1) 0.016
Treated hypertension 69 047 (30.5) 34 237 (28.4) 348 100 (32.9) < 0.001
Family history of CVD 1 486 (0.7) 691 (0.6) 795 (0.8) < 0.001
SBP/mmHg 131.2±16.3 130.6±16.7 131.9±15.9 < 0.001
DBP/mmHg 81.6±9.6 80.8±9.6 82.5±9.5 < 0.001
BMI/(kg/m2) 23.3±2.8 23.2±2.9 23.3±2.7 < 0.001
FBG/(mg/dL) 103.6±30.8 101.8±27.2 105.7±34.3 < 0.001
TG/(mg/dL) 145.5 (111.5, 179.1) 141.6 (106.4, 172.8) 151.2 (116.4, 185.7) < 0.001
TC/(mg/dL) 190.2±37.8 194.3±37.7 185.6±37.3 0.030
HDL-C/(mg/dL) 50.3±12.9 52.0±12.4 48.5±13.1 < 0.001
LDL-C/(mg/dL) 109.7±31.0 111.5±31.3 107.2±30.6 < 0.001
TyG index 8.7 (8.3, 9.1) 8.7 (8.2, 9.0) 8.8 (8.3, 9.1) < 0.001

图1

甘油三酯-葡萄糖指数不同分组的心血管病发病和死亡的Kaplan-Meier曲线"

表2

甘油三酯-葡萄糖指数与心血管病发病和死亡的关联"

Quartile Number of cases Case per 1 000 person-years Model 1 Model 2 Model 3 Model 4
HR (95%CI) P HR (95%CI) P HR (95%CI) P HR (95%CI) P
Quartile 1
(≤8.32)		 1 890 4.93 Reference Reference Reference Reference
Quartile 2
(>8.32-8.68)		 2 169 5.56 1.12
(1.05-1.19)		 < 0.001 1.04
(0.98-1.10)		 0.244 1.02
(0.96-1.08)		 0.611 1.02
(0.96-1.08)		 0.611
Quartile 3
(>8.68-9.10)		 2 621 6.67 1.34
(1.26-1.42)		 < 0.001 1.19
(1.12-1.26)		 < 0.001 1.15
(1.08-1.22)		 < 0.001 1.15
(1.08-1.22)		 < 0.001
Quartile 4
(>9.10)		 3 135 8.00 1.61
(1.52-1.70)		 < 0.001 1.50
(1.41-1.58)		 < 0.001 1.42
(1.34-1.51)		 < 0.001 1.42
(1.34-1.51)		 < 0.001

图2

按性别分组的甘油三酯-葡萄糖指数与心血管病发病和死亡的非线性关联"

图3

不同性别、年龄亚组中甘油三酯-葡萄糖指数与心血管病发病和死亡的关联"

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ISSN 1671-167X
CN 11-4691/R
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