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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (4): 610-616. doi: 10.19723/j.issn.1671-167X.2024.04.011

• 论著 • 上一篇    下一篇

甘油三酯葡萄糖指数与男性肾结石风险的关联

郑生旗1,花天池1,殷桂草1,张伟1,姚曳2,*(),李一帆1,*()   

  1. 1. 扬州大学附属医院泌尿外科, 江苏扬州 225001
    2. 苏北人民医院疝儿外科, 江苏扬州 225001
  • 收稿日期:2024-03-15 出版日期:2024-08-18 发布日期:2024-07-23
  • 通讯作者: 姚曳,李一帆 E-mail:821301725@qq.com;yfli@bjmu.edu.cn
  • 基金资助:
    国家自然科学基金(82002675);江苏省高等学校自然科学研究面上项目(20KJB320014);江苏省科技计划-青年基金项目(BK2020938)

Association between the triglyceride-glucose index and the incidence of nephrolithiasis in male individuals

Shengqi ZHENG1,Tianchi HUA1,Guicao YIN1,Wei ZHANG1,Ye YAO2,*(),Yifan LI1,*()   

  1. 1. Department of Urology, Affiliated Hospital of Yangzhou University, Yangzhou 225001, Jiangsu, China
    2. Department of Hernia and Pediatric Surgery, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu, China
  • Received:2024-03-15 Online:2024-08-18 Published:2024-07-23
  • Contact: Ye YAO,Yifan LI E-mail:821301725@qq.com;yfli@bjmu.edu.cn
  • Supported by:
    the National Natural Science Foundation of China(82002675);Jiangsu Natural Science Research of Colleges and Universities-General Project(20KJB320014);Jiangsu Science and Technology Program-Youth Fund Project(BK2020938)

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摘要：

目的: 评估甘油三酯葡萄糖(triglyceride-glucose，TyG)指数与肾结石风险间的关联性，并探讨在不同人群中的效应差异。方法: 通过横断面研究分析84 968名成年体检者的受检记录，将体检者根据TyG指数分为三个分位组(低、中、高)。采用多因素Logistic回归模型评估TyG指数与肾结石风险之间的关联，使用分段线性回归模型探讨TyG指数与肾结石风险之间的非线性剂量-反应关系，并进行亚组分析以探究不同人群中的效应差异。结果: 随着TyG指数的增加，肾结石的患病率呈上升趋势，从低TyG指数组的4.36%增加到高TyG指数组的8.96%(P < 0.001)。在调整了多种因素后，中、高TyG指数组的男性与低TyG指数组男性相比，肾结石的风险分别增加了1.18倍(95%CI: 1.07~1.31，P=0.002)和1.29倍(95%CI: 2.08~2.47，P < 0.001)。然而，在女性中，这一关联在调整后并不显著(OR=0.98，95%CI: 0.82~1.16，P=0.778)。非线性分析显示，在男性中，TyG指数在8.98的折点以下存在显著关联(OR=1.40，95%CI: 1.24~1.58，P < 0.001)，而在该折点及以上则不显著(OR=0.91，95%CI: 0.78~1.06，P=0.24)。亚组分析表明，TyG指数与肾结石风险之间的关系在不同年龄、不同BMI和高血压状态下均较为稳定。结论: TyG指数与男性肾结石风险呈正相关，且这种关系表现为非线性剂量-反应关系; TyG指数有助于识别高风险的肾结石男性患者，但需进一步探讨其潜在机制及在不同人群的普遍性。

关键词: 肾结石, 甘油三酯葡萄糖指数, 代谢综合征, 胰岛素抵抗

Abstract:

Objective: To analyze the association between the triglyceride-glucose (TyG) index and the risk of nephrolithiasis across various demographic and clinical subgroups, aiming to enhance early diagnosis and treatment of nephrolithiasis and promote personalized care in diverse populations. Methods: This cross-sectional study analyzed the medical records of 84 968 adults, stratified into three categories (low, middle, high) according to their TyG index scores. To evaluate the association between the TyG index and nephrolithiasis risk, multivariable Logistic regression models were employed, adjusting for potential confounders. Additionally, piecewise linear regression models were used to investigate the non-linear dynamics of the TyG index's relationship with nephrolithiasis risk. Subgroup analyses were performed to explore variations in the effects of the TyG index across different demographic and clinical populations. Results: Increasing TyG index was associated with a higher risk of nephrolithiasis, rising from 4.36% in the low group to 8.96% in the high group (P < 0.001). In adjusted models, males in the middle and high TyG index categories demonstrated significantly elevated risks of nephrolithiasis, with odds ratios of 1.18 (95%CI: 1.07-1.31, P=0.002) and 1.29 (95%CI: 1.15-1.45, P < 0.001), respectively. Conversely, in females, the association was not statistically significant post-adjustment (OR=0.98, 95%CI: 0.82-1.16, P=0.778). Among males, for each unit increment in the TyG index below the critical threshold of 8.98, there was a notable 40% escalation in the risk of developing nephrolithiasis (OR=1.40, 95%CI: 1.24-1.58, P < 0.001). Surpassing this threshold, the TyG index no longer conferred a significant increase in risk (OR=0.91, 95%CI: 0.78-1.06, P=0.24). Subgroup analyses indicated that this association remained stable regardless of age, BMI, or hypertension status. Conclusion: The TyG index is positively associated with the risk of nephrolithiasis in males, demonstrating a nonlinear dose-response relationship that becomes especially pronounced at certain index levels. This biomarker could potentially serve as a valuable clinical tool for identifying males who are at a high risk of developing nephrolithiasis, thereby enabling targeted preventive strategies. Further research is urgently needed to explore the underlying mechanisms and to verify the applicability of these results across different populations.

Key words: Nephrolithiasis, Triglyceride-glucose index, Metabolic syndrome, Insulin resistance

中图分类号: 

  • R692.4

图1

体检人群样本选择流程图"

表1

依据甘油三酯葡萄糖指数三分位分组的研究人群基线特征"

Characteristics Low TyG index
(n= 28 248)		 Middle TyG index
(n=27 958)		 High TyG index
(n=28 762)		 P
Age/years, $\bar x \pm s$ 42.78±13.90 47.96±14.43 49.06±13.22 < 0.001
Gender, n(%) < 0.001
  Female 18 023 (63.80) 11 804 (42.22) 7 418 (25.79)
  Male 10 225 (36.20) 16 154 (57.78) 21 344 (74.21)
Nephrolithiasis, n(%) < 0.001
  No 27 016 (95.64) 26 150 (93.53) 26 184 (91.04)
  Yes 1 232 (4.36) 1 808 (6.47) 2 578 (8.96)
Hypertension, n(%) < 0.001
  No 23 609 (83.58) 18 757 (67.09) 15 093 (52.48)
  Yes 4 639 (16.42) 9 201 (32.91) 13 669 (47.52)
BMI category, n(%) < 0.001
  Normal 21 087 (74.65) 13 808 (49.39) 8 140 (28.30)
  Overweight 6 045 (21.40) 10 793 (38.61) 13 900 (48.33)
  Obesity 1 116 (3.95) 3 356 (12.00) 6 721 (23.37)
BMI/(kg/m2), $\bar x \pm s$ 22.26±2.95 24.25±3.25 25.87±3.25 < 0.001
FBG/(mmol/L), $\bar x \pm s$ 5.00±0.45 5.24±0.50 5.46±0.57 < 0.001
Cr/(μmol/L), $\bar x \pm s$ 61.67±18.07 67.17±18.78 70.91±20.43 < 0.001
TC/(mmol/L), $\bar x \pm s$ 4.53±0.82 4.87±0.87 5.17±0.95 < 0.001
TG/(mmol/L), $\bar x \pm s$ 0.77±0.18 1.34±0.23 2.93±1.86 < 0.001
HDL-C/(mmol/L), $\bar x \pm s$ 1.53±0.33 1.32±0.29 1.12±0.24 < 0.001
LDL-C/(mmol/L), $\bar x \pm s$ 2.52±0.66 2.89±0.71 2.90±0.78 < 0.001
SU/(μmol/L), $\bar x \pm s$ 298.77±77.09 340.55±84.22 386.92±89.47 < 0.001

表2

甘油三酯葡萄糖指数与肾结石风险的关联分析"

Items Model 1 Model 2 Model 3
OR (95%CI) P OR (95%CI) P OR (95%CI) P
Female
TyG index 1.25 (1.14, 1.38) < 0.001 1.09 (0.97,
1.22)		 0.150 0.98 (0.82, 1.16) 0.778
TyG index tertile
  Low Reference Reference Reference
  Middle 1.12 (0.99, 1.28) 0.081 1.00 (0.87, 1.15) 0.998 0.91 (0.78, 1.06) 0.218
  High 1.34 (1.16, 1.54) < 0.001 1.08 (0.92, 1.27) 0.362 0.91 (0.74, 1.13) 0.405
P for trend < 0.001 0.406 0.430
Male
TyG index 1.34 (1.27, 1.40) < 0.001 1.19 (1.13, 1.25) < 0.001 1.19 (1.08, 1.30) < 0.001
TyG index tertile
  Low Reference Reference Reference
  Middle 1.33 (1.21, 1.46) < 0.001 1.20 (1.09, 1.32) < 0.001 1.18 (1.07, 1.31) 0.002
  High 1.67 (1.52, 1.82) < 0.001 1.38 (1.26, 1.51) < 0.001 1.29 (1.15,
1.45)		 < 0.001
P for trend < 0.001 < 0.001 < 0.001

图2

性别差异对甘油三酯葡萄糖指数与肾结石风险关系的影响"

表3

分段线性回归模型分析"

Outcome: Nephrolithiasis OR (95%CI) P
Female
Fitting model by standard linear regression 0.98 (0.82, 1.16) 0.778
Inflection point of TyG index 8.99
  ＜8.99 0.90 (0.75,
1.09)		 0.283
  ≥8.99 1.43 (0.95, 2.15) 0.086
Male
Fitting model by standard linear regression 1.19 (1.08, 1.30) < 0.001
Inflection point of TyG index 8.98
  ＜8.98 1.40 (1.24, 1.58) < 0.001
  ≥8.98 0.91 (0.78,
1.06)		 0.240
P for Log-likelihood ratio test Female: 0.048, Male: < 0.001

表4

基于性别分层的甘油三酯葡萄糖指数与肾结石风险关联的亚组分析"

Items Male Female
OR (95%CI) P P interaction OR (95%CI) P P interaction
Age/years 0.174 0.727
  ＜60 1.16 (1.05,
1.27)		 0.002 1.01 (0.85, 1.20) 0.932
  ≥60 1.29 (1.10, 1.51) 0.002 1.07 (0.76, 1.50) 0.700
Hypertension 0.413 0.187
  No 1.20 (1.07, 1.35) 0.002 0.91 (0.75, 1.10) 0.316
  Yes 1.13 (1.01, 1.27) 0.032 1.13 (0.84, 1.53) 0.418
BMI category 0.104 0.196
  Normal 1.33 (1.12, 1.58) 0.001 1.02 (0.82, 1.25) 0.886
  Overweight 1.20 (1.06, 1.37) 0.005 0.79 (0.57, 1.08) 0.142
  Obesity 1.00 (0.83, 1.22) 0.960 1.35 (0.79, 2.31) 0.278
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ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

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