論文丨老年2型糖尿病患者死亡風險預測的新型復合指標研究

論文發表

近日，由我院王帆教授（共同通訊作者），公衛學院直博生王祎寧（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”發表于期刊《BMC Endocrine Disorders》（JCR Q2）。該期刊聚焦內分泌疾病的預防、診斷與治療，涵蓋臨床、基礎與轉化研究及相關新技術進展。本研究成果體現了王帆教授團隊在社區慢病管理與預防方面的積極探索。

本研究旨在評估甘油三酯-葡萄糖（TyG）指數聯合肥胖指標構建的新型復合指標，對老年2型糖尿病（T2DM）患者全因死亡風險的預測效能，并探討腎功能障礙的中介作用。基于上海市標準化糖尿病管理系統，研究納入2020-2024年60歲及以上T2DM患者30.7萬例，中位隨訪時間19個月。結果顯示，各復合指標與死亡風險均呈U形關聯，整體預測能力優于單一TyG指數；其中TyG-ABSI組合指標的預測效能最佳，風險拐點為0.69。進一步中介分析表明，腎功能下降部分介導了高TyG-ABSI與死亡風險增加之間的關聯。本研究為老年糖尿病人群的風險分層與個體化管理提供了實證依據，提示該復合指標在臨床實踐及公共衛生干預中的潛在應用價值。

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）指數反映，并被認為與肥胖發生相互作用。盡管近期研究已將TyG與肥胖指標相結合，用于預測心血管疾病及死亡風險，但很少有研究納入新型人體測量指標，也較少在糖尿病人群中評估這些關聯。本研究旨在評估TyG 相關復合指標是否能提高對老年2型糖尿病（T2DM）患者全因死亡的預測能力；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年上海市標準化糖尿病管理體系中307161名60歲以上的2型糖尿病患者。死亡結局通過鏈接上海市死亡統計登記系統數據獲取，隨訪截至2024年12月31日。通過Cox比例風險模型和限制性立方樣條檢驗TyG相關復合指標與全因死亡率之間的關聯，并在拐點兩側分別建立兩段式Cox 回歸模型。通過受試者工作特征（ROC）曲線分析比較不同指標的預測能力。采用中介分析評估估算腎小球濾過率（eGFR）的中介效應。

結果在中位隨訪19個月后，共發生14,536例（4.7%）死亡。五個復合指標與全因死亡率之間均呈U形關系。所有復合指標均優于單一TyG指數，其中TyG-ABSI預后效能最高。與TyG-ABSI第三四分位數（Q3）相比，第一四分位（Q1）的風險比（HR）為1.13（95%置信區間[CI] 1.08–1.19），第五四分位（Q5）為1.12（95% CI 1.06–1.18）。閾值分析進一步確定拐點為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降低介導了高TyG-ABSI與死亡風險增加之間24.3%的關聯。

結論TyG-ABSI在預測老年中國T2DM患者全因死亡方面表現出優越的預后準確性，呈U型模式。這些發現強調了保持最佳TyG和內臟肥胖水平的重要性，并支持將TyG-ABSI融入個性化風險管理和公共衛生策略。TyG-ABSI 在預測中國老年T2DM患者全因死亡方面表現出更高的預后準確性，且呈U形關聯。上述發現強調維持適宜的 TyG與內臟肥胖水平的重要性，并支持將 TyG-ABSI 納入個體化風險管理與公共衛生策略。

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

來源｜BMC Endocrine Disorders