基于左心室整体纵向应变及心肌做功探讨甘油三酯⁃葡萄糖指数与亚临床左心室功能障碍的相关性研究
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1南京中医药大学附属医院功能检查科,江苏 南京 210029 ; 2.南京医科大学第一附属医院心血管内科,江苏 南京 210029

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R540.45

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国家自然科学基金(81901416);江苏省中医院创新发展基金专项(y2023cx30)


Association between triglyceride⁃glucose index and subclinical left ventricular dysfunction: a study based on left ventricular global longitudinal strain and myocardial work
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1Department of Functional Examination,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029 ; 2.Department of Cardiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029 ,China

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    摘要:

    目的:探讨甘油三酯-葡萄糖(triglyceride-glucose,TyG)指数与亚临床左心室收缩功能障碍的独立关联,分析其对左心室整体纵向应变(global longitudinal strain,GLS)及左心室做功指数的影响。方法:纳入2024年8月—2025年2月收治的103例患者,采集患者临床参数、生化指标及超声心动图数据,计算TyG指数。通过GE EchoPAC工作站获取GLS及左室做功参数,包括整体做功指数(global work index,GWI)、整体有用功指数(global constructive work,GCW)、整体无用功指数(global wasted work,GWW)和整体做功效率指数(global work efficiency,GWE),采用多因素Logistic回归分析TyG指数与左室功能异常的独立关联。绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估TyG指数对左心室功能障碍的预测效能,计算曲线下面积(area under the curve,AUC)、最佳截断值、灵敏度及特异度。结果:高TyG指数组与低TyG指数组相比,高血压(67.31% vs. 43.14%)、糖尿病(42.31% vs. 7.84%)及高脂血症(34.62% vs. 3.92%)患病率显著升高(P均<0.05)。GLS绝对值(-17.60±2.65 vs. -19.82±2.12)、GWI[(1 672.33±308.58)mmHg% vs.(1 932.31±280.26)mmHg%)及 GCW[(1 999.46±324.11)mmHg% vs. (2 299.20±323.32)mmHg%]均显著降低(P均< 0.001)。调整年龄、性别、BMI、血压、血脂等混杂因素后,TyG指数升高仍为GLS 降低(OR=2.982,95%CI:1.182~7.522,P=0.021)、GWI降低(OR=3.168,95%CI:1.302~7.706,P=0.011)及GCW降低(OR=2.836, 95%CI:1.250~7.309,P=0.021)的独立危险因素。ROC曲线显示出TyG指数对GLS、GWI及GCW降低的预测效能,AUC分别为 0.725、0.697、0.683。结论:TyG指数升高与GLS及心肌做功能力下降独立相关,是亚临床左心室功能障碍的潜在生物标志物, 提示其在代谢性心血管疾病早期风险评估中的临床应用价值。

    Abstract:

    Objective:To investigate the independent association between the triglyceride-glucose(TyG)index and subclinical left ventricular(LV)systolic dysfunction,and to analyze its impact on left ventricular global longitudinal strain(GLS)and myocardial work indices. Methods:A total of 103 patients admitted from August 2024 to February 2025 were enrolled. Clinical parameters,biochemical indicators,and echocardiographic data were collected,and the TyG index was calculated. GLS and LV myocardial work parameters, including global work index(GWI),global constructive work(GCW),global wasted work(GWW),and global work efficiency(GWE) were obtained using GE EchoPAC software. Multivariate logistic regression analysis was employed to assess the independent association between the TyG index and impaired LV function. Receiver operating characteristic(ROC)curves were plotted to evaluate the predictive efficacy of the TyG index for LV dysfunction,calculating the area under the curve(AUC),optimal cutoff value, sensitivity,and specificity. Results:Compared to the low - TyG group,the high - TyG group exhibited significantly higher prevalence rates of hypertension(67.31% vs. 43.14%),diabetes(42.31% vs. 7.84%),and dyslipidemia(34.62% vs. 3.92%)(all P < 0.05). The absolute values of GLS(-17.60 ± 2.65 vs. -19.82 ± 2.12),GWI(1 672.33 ± 308.58 vs. 1 932.31 ± 280.26 mmHg%),and GCW (1 999.46 ± 324.11 vs. 2 299.20 ± 323.32 mmHg%)were significantly lower in the high TyG group(all P < 0.001). After adjusting for age,sex,body mass index(BMI),blood pressure,dyslipidemia,and other confounders,an elevated TyG index remained an independent risk factor for reduced GLS(OR=2.982,95% CI:1.182-7.522,P=0.021),reduced GWI(OR=3.168,95% CI:1.302- 7.706,P=0.011),and diminished GCW(OR=2.836,95% CI:1.250-7.309,P=0.021). ROC curve analysis demonstrated the predictive efficacy of the TyG index for reduced GLS,GWI,and GCW,with AUC values of 0.725,0.697,and 0.683,respectively. Conclusion:An elevated TyG index is independently associated with reduced GLS and myocardial work capacity,serving as a potential biomarker for subclinical LV dysfunction and highlighting its clinical utility in early risk assessment for metabolic cardiovascular diseases.

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陈超,陶炜伟,陆美娟,何安霞,刘加宝.基于左心室整体纵向应变及心肌做功探讨甘油三酯⁃葡萄糖指数与亚临床左心室功能障碍的相关性研究[J].南京医科大学学报(自然科学版),2025,45(11):1626-1633

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  • 收稿日期:2025-04-07
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  • 在线发布日期: 2025-11-12
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