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(TyG)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;2.南京医科大学第一附属医院

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国家自然科学基金


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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1.Affiliated Hospital of Nanjing University of Chinese Medicine;2.The First Affiliated Hospital with Nanjing Medical University

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    摘要:

    目的:探讨甘油三酯-葡萄糖(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(GLS)及左室做功指数的影响。方法:纳入2024年8月至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(GWI、GCW、GWW、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(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(AUC)、最佳截断值、灵敏度及特异度。结果:高TyG指数组高血压(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(均P<0.05)。与低TyG组相比,高TyG组GLS绝对值(-17.60±2.65 vs. -19.82±2.12)、GWI(1672.33±308.58 vs. 1932.31±280.26 mmHg%)及GCW(1999.46±324.11 vs. 2299.20±323.32 mmHg%)均显著降低(均P<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指数升高与左心室整体应变及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 between August 2024 and 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 (global work index, GWI; global constructive work, GCW; global wasted work, GWW; 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: 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). Compared to the low-TyG group, the high-TyG group showed reduced absolute GLS (-17.60 ± 2.65 vs. -19.82 ± 2.12), lower GWI (1672.33 ± 308.58 vs. 1932.31 ± 280.26 mmHg%), and decreased GCW (1999.46 ± 324.11 vs. 2299.20 ± 323.32 mmHg%) (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 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 impaired LV global strain and myocardial work capacity, serving as a potential biomarker for subclinical LV dysfunction. This highlights its clinical utility in early risk assessment for metabolic cardiovascular diseases.

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  • 收稿日期:2025-04-07
  • 最后修改日期:2025-08-30
  • 录用日期:2025-10-29
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