TyG指数联合冠周脂肪衰减指数与2型糖尿病患者冠状动脉狭窄的关联分析-现代医学

TyG指数联合冠周脂肪衰减指数与2型糖尿病患者冠状动脉狭窄的关联分析

单位：1. 延安大学延安医学院, 陕西延安 716000;
2. 延安大学附属医院全科医学科, 陕西延安 716000

关键词：冠状动脉周围脂肪组织脂肪衰减指数甘油三酯-葡萄糖指数 2型糖尿病冠状动脉狭窄

分类号：R587.1

出版年·卷·期（页码）：2026·54·第六期（968-975）

摘要：

目的：探讨甘油三酯-葡萄糖指数(TyG)联合冠状动脉周围脂肪衰减指数(FAI)与2型糖尿病(T2DM)患者冠状动脉狭窄的关系。方法：选取2023年10月至2024年11月于延安大学附属医院行冠状动脉CT血管造影(CCTA)的T2DM患者428例进行横断面研究。根据CCTA结果将患者分为无冠状动脉狭窄组(n=107)和冠状动脉狭窄组(n=321)。收集患者临床资料及实验室指标，计算TyG指数，测量右冠状动脉(RCA)、左前降支(LAD)及左回旋支(LCX)的FAI值。采用多因素Logistic回归分析TyG指数、RCA-FAI与冠状动脉狭窄的关联；对模型中有统计学意义的连续性指标绘制ROC曲线，采用DeLong检验比较各指标AUC的差异；构建限制性立方样条(RCS)模型探索剂量-反应关系并确定风险拐点；根据拐点构建四分组联合变量进行分层Logistic回归分析。结果：多因素Logistic 回归分析显示，TyG指数(OR=2.442，95%CI 1.531~3.901)和 RCA-FAI(OR=1.062，95%CI 1.011~1.112)均为2型糖尿病患者冠状动脉狭窄的影响因素(均P<0.05)。ROC曲线分析显示，TyG指数联合RCA-FAI的AUC为0.733(95%CI 0.682~0.800)，对T2DM患者冠状动脉狭窄的识别效能优于单一指标，差异有统计学意义(均P<0.05)。RCS分析显示，TyG指数、RCA-FAI与冠状动脉狭窄之间均存在非线性剂量-反应关系。联合分层分析显示，高TyG/高FAI组冠状动脉狭窄的患病风险是低TyG/低FAI参照组的4.789倍(OR=4.789，95%CI 2.312~9.922，P=0.006)。结论：TyG指数和RCA-FAI与2型糖尿病患者冠状动脉狭窄相关，二者联合是评估T2DM患者冠状动脉狭窄的有效识别指标。

Objective: To investigate the association of triglyceride-glucose(TyG) index combined with pericoronary fat attenuation index(FAI) with coronary artery stenosis in patients with type 2 diabetes mellitus(T2DM).Methods: A cross-sectional study was conducted on 428 T2DM patients who underwent coronary computed tomography angiography(CCTA) at the Affiliated Hospital of Yan'an University from October 2023 to November 2024. According to CCTA findings, the patients were divided into non-stenosis group(n=107) and coronary stenosis group(n=321). Clinical data and laboratory parameters were collected, TyG index was calculated, and FAI values of the right coronary artery(RCA), left anterior descending artery(LAD), and left circumflex artery(LCX) were measured. Multivariate logistic regression was performed to analyze the association of TyG index and RCA-FAI with coronary stenosis. Receiver operating characteristic(ROC) curves were plotted for the statistically significant continuous variables in the regression model, and the DeLong test was used to compare the differences in the area under the curve(AUC) among TyG index, RCA-FAI, and their combination. A restricted cubic spline(RCS) model was constructed to explore the dose-response relationship and identify the risk inflection point. Based on the inflection point, a four-group combined variable was established for stratified logistic regression analysis.Results: Multivariate logistic regression analysis showed that both TyG index(OR=2.442，95%CI 1.531-3.901) and RCA-FAI(OR=1.062，95%CI 1.011-1.112) were associated factors for coronary stenosis in T2DM patients(all P<0.05). ROC curve analysis demonstrated that the combination of TyG index and RCA-FAI yielded an AUC of 0.733(95%CI 0.682-0.800), which was significantly higher than that of either indicator alone(all P<0.05). RCS model analysis revealed non-linear dose-response relationships between TyG index, RCA-FAI and coronary stenosis. Combined stratified analysis indicated that compared with the low TyG/low FAI group, the risk of coronary stenosis was significantly elevated in the high TyG/high FAI group(OR=4.789, 95%CI 2.312-9.922, P=0.006). Conclusion: Both TyG index and RCA-FAI are associated with coronary stenosis in T2DM patients, and their combination serves as an effective indicator for the assessment of coronary stenosis.

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