論文發(fā)表

近日，由我院王帆教授（共同通訊作者），公衛(wèi)學(xué)院直博生王祎寧（共同第一作者），以及上海市疾控中心施燕主任（共同通訊作者）、吳菲（共同第一作者）等專(zhuān)家合作完成的論文“Combining triglyceride?glucose index and novel anthropometric measures to predict mortality risk in patients with T2DM: a prospective cohort study”發(fā)表于期刊《BMC Endocrine Disorders》（JCR Q2）。該期刊聚焦內(nèi)分泌疾病的預(yù)防、診斷與治療，涵蓋臨床、基礎(chǔ)與轉(zhuǎn)化研究及相關(guān)新技術(shù)進(jìn)展。本研究成果體現(xiàn)了王帆教授團(tuán)隊(duì)在社區(qū)慢病管理與預(yù)防方面的積極探索。

本研究旨在評(píng)估甘油三酯-葡萄糖（TyG）指數(shù)聯(lián)合肥胖指標(biāo)構(gòu)建的新型復(fù)合指標(biāo)，對(duì)老年2型糖尿?。═2DM）患者全因死亡風(fēng)險(xiǎn)的預(yù)測(cè)效能，并探討腎功能障礙的中介作用?；谏虾Ｊ袠?biāo)準(zhǔn)化糖尿病管理系統(tǒng)，研究納入2020-2024年60歲及以上T2DM患者30.7萬(wàn)例，中位隨訪時(shí)間19個(gè)月。結(jié)果顯示，各復(fù)合指標(biāo)與死亡風(fēng)險(xiǎn)均呈U形關(guān)聯(lián)，整體預(yù)測(cè)能力優(yōu)于單一TyG指數(shù)；其中TyG-ABSI組合指標(biāo)的預(yù)測(cè)效能最佳，風(fēng)險(xiǎn)拐點(diǎn)為0.69。進(jìn)一步中介分析表明，腎功能下降部分介導(dǎo)了高TyG-ABSI與死亡風(fēng)險(xiǎn)增加之間的關(guān)聯(lián)。本研究為老年糖尿病人群的風(fēng)險(xiǎn)分層與個(gè)體化管理提供了實(shí)證依據(jù)，提示該復(fù)合指標(biāo)在臨床實(shí)踐及公共衛(wèi)生干預(yù)中的潛在應(yīng)用價(jià)值。

作者/Authors

Yining Wang1?, Fei Wu2?, Hongfei Mo1,3, Qinghua Yan2, Hongjie Chu1, Mengyan Wang2, Yang Zhou4, Huiting Yu5, Shuyue Sun1,3, Minna Cheng2, Fan Wang3,6* and Yan Shi2*

1.School of Public Health, Fudan University, Shanghai, China

2.Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China

3.Fudan Development Institute, Fudan University, Shanghai, China

4.School of Philosophy, Fudan University, Shanghai, China

5.Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China

6.Health Communication Institute, Fudan University, Shanghai, China

?Yining Wang and Fei Wu contributed equally as co-first authors.

* Corresponding authors

摘要/Abstract

背景胰島素抵抗可由甘油三酯-葡萄糖（TyG）指數(shù)反映，并被認(rèn)為與肥胖發(fā)生相互作用。盡管近期研究已將TyG與肥胖指標(biāo)相結(jié)合，用于預(yù)測(cè)心血管疾病及死亡風(fēng)險(xiǎn)，但很少有研究納入新型人體測(cè)量指標(biāo)，也較少在糖尿病人群中評(píng)估這些關(guān)聯(lián)。本研究旨在評(píng)估TyG 相關(guān)復(fù)合指標(biāo)是否能提高對(duì)老年2型糖尿?。═2DM）患者全因死亡的預(yù)測(cè)能力；此外探究腎功能障礙的潛在中介作用。

方法本研究分析了2020年至2024年上海市標(biāo)準(zhǔn)化糖尿病管理體系中307161名60歲以上的2型糖尿病患者。死亡結(jié)局通過(guò)鏈接上海市死亡統(tǒng)計(jì)登記系統(tǒng)數(shù)據(jù)獲取，隨訪截至2024年12月31日。通過(guò)Cox比例風(fēng)險(xiǎn)模型和限制性立方樣條檢驗(yàn)TyG相關(guān)復(fù)合指標(biāo)與全因死亡率之間的關(guān)聯(lián)，并在拐點(diǎn)兩側(cè)分別建立兩段式Cox 回歸模型。通過(guò)受試者工作特征（ROC）曲線分析比較不同指標(biāo)的預(yù)測(cè)能力。采用中介分析評(píng)估估算腎小球?yàn)V過(guò)率（eGFR）的中介效應(yīng)。

結(jié)果在中位隨訪19個(gè)月后，共發(fā)生14,536例（4.7%）死亡。五個(gè)復(fù)合指標(biāo)與全因死亡率之間均呈U形關(guān)系。所有復(fù)合指標(biāo)均優(yōu)于單一TyG指數(shù)，其中TyG-ABSI預(yù)后效能最高。與TyG-ABSI第三四分位數(shù)（Q3）相比，第一四分位（Q1）的風(fēng)險(xiǎn)比（HR）為1.13（95%置信區(qū)間[CI] 1.08–1.19），第五四分位（Q5）為1.12（95% CI 1.06–1.18）。閾值分析進(jìn)一步確定拐點(diǎn)為0.69，在閾值以上HR為1.08（95% CI 1.05–1.11），以下則為0.85（95% CI 0.81–0.89）。eGFR降低介導(dǎo)了高TyG-ABSI與死亡風(fēng)險(xiǎn)增加之間24.3%的關(guān)聯(lián)。

結(jié)論TyG-ABSI在預(yù)測(cè)老年中國(guó)T2DM患者全因死亡方面表現(xiàn)出優(yōu)越的預(yù)后準(zhǔn)確性，呈U型模式。這些發(fā)現(xiàn)強(qiáng)調(diào)了保持最佳TyG和內(nèi)臟肥胖水平的重要性，并支持將TyG-ABSI融入個(gè)性化風(fēng)險(xiǎn)管理和公共衛(wèi)生策略。TyG-ABSI 在預(yù)測(cè)中國(guó)老年T2DM患者全因死亡方面表現(xiàn)出更高的預(yù)后準(zhǔn)確性，且呈U形關(guān)聯(lián)。上述發(fā)現(xiàn)強(qiáng)調(diào)維持適宜的 TyG與內(nèi)臟肥胖水平的重要性，并支持將 TyG-ABSI 納入個(gè)體化風(fēng)險(xiǎn)管理與公共衛(wèi)生策略。

BackgroundInsulin resistance, indicated by triglyceride-glucose (TyG) index, is thought to interact with obesity. Although recent studies have combined TyG with obesity measures to predict cardiovascular disease and mortality, few studies have incorporated novel anthropometric indicators, nor assessed these associations in diabetic populations. This study aims to assess whether TyG-related composite indices improve the prediction of all-cause mortality among elderly patients with type 2 diabetes mellitus (T2DM). Additionally, it seeks to explore the potential mediating role of renal dysfunction.

MethodsWe analyzed 307,161 individuals with T2DM aged over 60?years enrolled in the Shanghai Standardized Diabetes Management System from 2020 to 2024. Mortality outcomes were obtained by linking to the Shanghai Vital Statistics Registry up to 31 December, 2024. The association between TyG-related composite indices and all-cause mortality was examined using Cox proportional hazards models and restricted cubic splines. Two-piecewise Cox regressions were further developed for each side of the inflection point. Receiver operating characteristic curve analysis compared the predictive capacities of various indices. Mediation analysis was conducted to investigate the mediating effects of estimated glomerular filtration rate (eGFR).

ResultsAfter a median follow-up period of 19?months, 14,536 (4.7%) deaths occurred. A U-shaped relationship was observed between five composite biomarkers and all-cause mortality. All composite indices outperformed the standalone TyG index, with TyG-a body shape index (TyG-ABSI) showing the highest prognostic efficacy. Notably, compared to the third quartile (Q3) of TyG-ABSI, hazard ratios (HRs) were 1.13 (95% confidence interval [CI] 1.08–1.19) for the first quartile (Q1) and 1.12 (95% CI 1.06–1.18) for the fifth quartile (Q5). Threshold analysis further identified an inflection point at 0.69, with HRs of 1.08 (95% CI 1.05–1.11) above and 0.85 (95% CI 0.81–0.89) below the threshold. Decreased eGFR mediated 24.3% of the association between the higher TyG-ABSI and increased mortality.

ConclusionsTyG-ABSI exhibited superior prognostic accuracy for predicting all-cause mortality in elderly Chinese T2DM patients, following a U-shaped pattern. These findings underscore the importance of maintaining optimal TyG and visceral obesity levels and support the integration of TyG-ABSI into personalized risk management and public health strategies.

關(guān)鍵詞/Key Words

triglyceride?glucose index; insulin resistance; obesity; all-cause mortality; type 2 diabetes mellitus

全文鏈接/Link

https://link.springer.com/article/10.1186/s12902-025-02132-7

來(lái)源｜BMC Endocrine Disorders