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Article(id=1199703042930078048, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199703037368430831, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.0544.2023.1012, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1681660800000, receivedDateStr=2023-04-17, revisedDate=null, revisedDateStr=null, acceptedDate=1692115200000, acceptedDateStr=2023-08-16, onlineDate=1763961094839, onlineDateStr=2025-11-24, pubDate=1701100800000, pubDateStr=2023-11-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1763961094839, onlineIssueDateStr=2025-11-24, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1763961094839, creator=13701087609, updateTime=1763961094839, updator=13701087609, issue=Issue{id=1199703037368430831, tenantId=1146029695717560320, journalId=1189873630562394117, year='2023', volume='48', issue='11', pageStart='1237', pageEnd='1358', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1763961093513, creator=13701087609, updateTime=1763961140964, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1199703236451070744, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199703037368430831, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1199703236451070745, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199703037368430831, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1344, endPage=1352, ext={EN=ArticleExt(id=1199703043307565427, articleId=1199703042930078048, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Association between triglyceride glucose index and its related derivative index and metabolic associated fatty liver disease in the elderly men, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To explore the association between triglyceride glucose (TyG) index and TyG-body mass index (TyG-BMI) and the prevalence of metabolic associated fatty liver disease (MAFLD) in the elderly men. Methods Totally 2290 elderly men were selected from January to December in 2021 in the Second Medical Center of Chinese PLA General Hospital, and divided into MAFLD group (n=1322) and non-MAFLD group (n=968). Multivariate logistic regression was used to analyze the association between TyG index, TyG-BMI and MAFLD. The receiver operating characteristic (ROC) curve was drawn to explore the predictive value of TyG index and TyG-BMI with MAFLD in the elderly men. Results Two thousand two hundred and ninety elderly men were (74.3±10.1) years old, and an average BMI of (24.63±2.70) kg/m2. BMI, γ‑glutamyl transaminase (γ‑GT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine (Scr), thyroid stimulating hormone (TSH), free triiodothyronine (FT3), the rate of smoking and drinking, and the prevalence of hypertension, diabetes, hyperuricemia, high triglyceride (TG), low high density lipoprotein cholesterol (HDL-C), hyperuricemia, thyroid nodules and cholelithiasis were all significantly higher in non-MAFLD group than those in MAFLD group (P<0.05), while the age of MAFLD group was lower than that of non-MAFLD group (P=0.003). Multivariate logistic regression analysis showed that the risk of MAFLD in patients of TyG quartile groups Q2, Q3, Q4 was 1.667 (95%CI 1.257-2.236, P<0.001), 2.004 (95%CI 1.482-2.710, P<0.001) and 5.420 (95%CI 3.266-8.995, P<0.001) times higher than that of TyG Q1, respectively. The risk of MAFLD in patients of TyG-BMI Q2, Q3, Q4 was 2.215 (95%CI 1.549-3.167, P<0.001), 2.809 (95%CI 1.723-4.580, P<0.001) and 2.513 (95%CI 1.253-5.040, P=0.009) times higher than that of TyG-BMI Q1, respectively. The ROC curve showed that areas under the curve (AUC) of MAFLD predicted by TyG index and TyG-BMI were 0.717 (95%CI 0.696-0.738) and 0.840 (95%CI 0.823-0.856), and the best cut-off values were 8.63 and 205.20, respectively. Moreover, the ROC curve showed that AUC of MAFLD in the elderly men without hyperlipidemia or diabetes predicted by TyG index and TyG-BMI were 0.653 (95%CI 0.622-0.684) and 0.840 (95%CI 0.818-0.862), and the best cut-off values were 8.42 and 202.66, respectively. In addition, AUC, accuracy, specificity, sensitivity, positive predictive value and negative predictive value predicted by TyG-BMI were higher than those by TyG index. Conclusions TyG index and TyG-BMI are significantly associated with MAFLD in the elderly men. Both TyG index and TyG-BMI have certain predictive value for the prevalence of MAFLD in the elderly men, and TyG-BMI may be better.

, correspAuthors=Ying-Jie Zhuang, authorNote=null, correspAuthorsNote=
E-mail:
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目的 探讨三酰甘油-葡萄糖(TyG)指数及其衍生指数三酰甘油-葡萄糖-体重指数(TyG-BMI)与老年男性人群代谢相关脂肪性肝病(MAFLD)患病风险之间的相关性。方法 选取2021年1-12月于解放军总医院第二医学中心门诊行年度体检的2290例老年男性，分为MAFLD组(n=1322)与非MAFLD组(n=968)。筛选MAFLD患病的混杂因素，采用多因素logistic回归分析TyG指数及TyG-BMI与MAFLD患病风险的相关性，并绘制受试者工作特征(ROC)曲线探讨其对老年男性MAFLD患病风险的预测价值。结果 2290例体检者年龄(74.3±10.1)岁，体重指数(BMI)为(24.63±2.70) kg/m2。MAFLD组BMI、γ-谷氨酰氨基转移酶(γ-GT)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、血肌酐(Scr)、促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)、吸烟、饮酒率，以及高血压、糖尿病、高尿酸血症、高甘油三酯(TG)血症、低高密度脂蛋白胆固醇(HDL-C)血症、甲状腺结节、胆系结石等的患病率明显高于非MAFLD组(P<0.05)，年龄低于非MAFLD组(P=0.003)。调整混杂因素后，多因素logistic回归分析显示，按TyG指数四分位数分组的Q2组、Q3组、Q4组患MAFLD的风险分别是Q1组的1.667倍(95%CI 1.257~2.236，P<0.001)、2.004倍(95%CI 1.482~2.710，P<0.001)、5.420倍(95%CI 3.266~8.995，P<0.001)；按TyG-BMI四分位数分组的Q2组、Q3组、Q4组患MAFLD的风险分别是Q1组的2.215倍(95%CI 1.549~3.167，P<0.001)、2.809倍(95%CI 1.723~4.580，P<0.001)、2.513倍(95%CI 1.253~5.040，P=0.009)。TyG指数及TyG-BMI预测老年男性MAFLD的ROC曲线下面积(AUC)分别为0.717(95%CI 0.696~0.738)、0.840(95%CI 0.823~0.856)，最佳截断值分别为8.63、205.20；在无高脂血症及糖尿病的老年男性中，TyG指数与TyG-BMI预测MAFLD的AUC分别为0.653(95%CI 0.622~0.684)、0.840(95%CI 0.818~0.862)，最佳截断值分别为8.42、202.66。TyG-BMI预测MAFLD的AUC、准确率、特异度、敏感度、阳性预测值、阴性预测值均高于TyG指数。结论 TyG指数及TyG-BMI高水平状态与老年男性MAFLD患病风险升高相关。TyG指数及TyG-BMI对老年男性MAFLD患病均有一定的预测价值，而TyG-BMI较TyG指数的预测价值更优。

, correspAuthors=庄颖洁, authorNote=null, correspAuthorsNote=
庄颖洁，E-mail：
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康娟，医学学士，主要从事慢性肝病方面的临床研究

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康娟，医学学士，主要从事慢性肝病方面的临床研究

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Hepatology, 2011, 54(3): 1082-1090., articleTitle=Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1199711030432596957, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, xref=1, ext=[AuthorCompanyExt(id=1199711030436791262, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, companyId=1199711030432596957, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Emergency Medicine, Outpatient Department of the Second Medical Center/National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China), AuthorCompanyExt(id=1199711030445179871, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, companyId=1199711030432596957, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1解放军总医院第二医学中心门诊部急诊医学科/国家老年疾病临床研究中心，北京 100853)]), AuthorCompany(id=1199711030520677348, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, xref=2, ext=[AuthorCompanyExt(id=1199711030524871653, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, companyId=1199711030520677348, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Gastroenterology, the Second Medical Center/National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China), AuthorCompanyExt(id=1199711030533260263, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, companyId=1199711030520677348, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2解放军总医院第二医学中心消化内科/国家老年疾病临床医学研究中心，北京 100853)])], figs=[ArticleFig(id=1199711034358464610, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, language=EN, label=Fig.1, caption=ROC curves of TyG index and TyG-BMI for predicting MAFLD in the elderly men, figureFileSmall=AecmPmbIEn8ABdjv1/ZHTQ==, figureFileBig=Xl2F8le1dOhVb1fgwuBBAg==, tableContent=null), ArticleFig(id=1199711034450739301, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, language=CN, label=图1, caption=TyG指数及TyG-BMI预测老年男性MAFLD患病风险的ROC曲线

TyG.三酰甘油-葡萄糖；TyG-BMI.三酰甘油-葡萄糖-体重指数；MAFLD.代谢相关脂肪性肝病；ROC.受试者工作特征；AUC.ROC曲线下面积

, figureFileSmall=AecmPmbIEn8ABdjv1/ZHTQ==, figureFileBig=Xl2F8le1dOhVb1fgwuBBAg==, tableContent=null), ArticleFig(id=1199711034580762734, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, language=EN, label=Fig.2, caption=ROC curves of TyG index and TyG-BMI for predicting MAFLD in the elderly men without hyperlipidemia or diabetes, figureFileSmall=DhpJL2ao2jHe3NrrtwT9ew==, figureFileBig=f6EMYg9C1txJ7vOwN07QRQ==, tableContent=null), ArticleFig(id=1199711034685620337, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, language=CN, label=图2, caption=TyG指数及TyG-BMI在无高脂血症及糖尿病的老年男性中预测MAFLD的ROC曲线

TyG.三酰甘油-葡萄糖；TyG-BMI.三酰甘油-葡萄糖-体重指数；MAFLD.代谢相关脂肪性肝病；ROC.受试者工作特征；AUC.ROC曲线下面积

, figureFileSmall=DhpJL2ao2jHe3NrrtwT9ew==, figureFileBig=f6EMYg9C1txJ7vOwN07QRQ==, tableContent=null), ArticleFig(id=1199711034815643766, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, language=EN, label=Tab.1, caption=

Comparison of clinical data between non MAFLD group and MAFLD group

, figureFileSmall=null, figureFileBig=null, tableContent=
指标 总体(n=2290) 非MAFLD组(n=968) MAFLD组(n=1322) t/χ2/Z P
年龄(岁, $\bar{x}±s$) 74.3±10.1 75.0±10.7 73.7±9.6 2.972 0.003
BMI (kg/m2, $\bar{x}±s$) 24.63±2.70 23.00±2.39 25.82±2.26 -28.538 <0.001
吸烟[例(%)] 6.163 0.013
否 1917(83.7) 832(86.0) 1085(82.1)
是 373(16.3) 136(14.0) 237(17.9)
饮酒 [例(%)] 14.143 <0.001
否 1258(54.9) 576(59.5) 682(51.6)
是 1032(45.1) 392(40.5) 640(48.4)
TBil(μmol/L, $\bar{x}±s$) 13.62±5.44 13.41±5.14 13.78±5.65 -1.599 0.110
DBil(μmol/L, $\bar{x}±s$) 5.22±1.71 5.18±1.67 5.25±1.75 -0.860 0.390
γ-GT[U/L, M(Q1, Q3)] 22.50(17.00, 31.00) 20.00(15.00, 27.00) 25.00(18.00, 35.00) 10.657 <0.001
ALT[U/L, M(Q1, Q3)] 17.00(13.00, 23.00) 15.20(12.00, 20.08) 18.30(14.08, 24.60) 9.805 <0.001
AST[U/L, M(Q1, Q3)] 19.10(16.78, 23.00) 19.00(16.40, 22.00) 19.40(17.00, 23.00) 2.180 0.029
BUN(mmol/L, $\bar{x}±s$) 6.02±1.75 6.00±1.78 6.03±1.73 -0.453 0.651
Scr(μmol/L, $\bar{x}±s$) 84.60±21.17 83.28±19.74 85.57±22.12 -2.558 0.011
TSH[μU/mL, M(Q1, Q3)] 2.15(1.55, 3.13) 2.08(1.49, 3.11) 2.18(1.60, 3.16) 1.993 0.046
FT3(pmol/L, $\bar{x}±s$) 4.74±0.59 4.70±0.59 4.77±0.60 -2.864 0.004
FT4(pmol/L, $\bar{x}±s$) 16.36±2.46 16.46±2.41 16.28±2.49 1.662 0.097
高血压[例(%)] 20.622 <0.001
否 1407(61.4) 647(66.8) 760(57.5)
是 883(38.6) 321(33.2) 562(42.5)
糖尿病[例(%)] 49.805 <0.001
否 1977(86.3) 893(92.3) 1084(82.0)
是 313(13.7) 75(7.7) 238(18.0)
高尿酸血症[例(%)] 37.347 <0.001
否 1869(81.6) 846(87.4) 1023(77.4)
是 421(18.4) 122(12.6) 299(22.6)
高TC血症[例(%)] 2.965 0.085
否 2163(94.5) 905(93.5) 1258(95.2)
是 127(5.5) 63(6.5) 64(4.8)
高TG血症[例(%)] 151.039 <0.001
否 1744(76.2) 861(88.9) 883(66.8)
是 546(23.8) 107(11.1) 439(33.2)
高LDL-C血症[例(%)] 1.688 0.194
否 1940(84.7) 809(83.6) 1131(85.6)
是 350(15.3) 159(16.4) 191(14.4)
低HDL-C血症[例(%)] 61.828 <0.001
否 1946(85.0) 889(91.8) 1057(80.0)
是 344(15.0) 79(8.2) 265(20.0)
颈动脉硬化[例(%)] 3.360 0.067
否 449(19.6) 207(21.4) 242(18.3)
是 1841(80.4) 761(78.6) 1080(81.7)
甲状腺结节[例(%)] 6.956 0.008
否 423(18.5) 203(21.0) 220(16.6)
是 1867(81.5) 765(79.0) 1102(83.4)
胆系结石[例(%)] 6.852 0.009
否 1859(81.2) 810(83.7) 1049(79.3)
是 431(18.8) 158(16.3) 273(20.7)
TyG指数 8.67±0.49 8.47±0.43 8.83±0.48 18.877 <0.001
TyG-BMI 214.00±29.09 194.99±24.61 227.92±23.74 32.291 <0.001
), ArticleFig(id=1199711034983415935, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, language=CN, label=表1, caption=

非MAFLD组与MAFLD组临床资料比较

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指标 总体(n=2290) 非MAFLD组(n=968) MAFLD组(n=1322) t/χ2/Z P
年龄(岁, $\bar{x}±s$) 74.3±10.1 75.0±10.7 73.7±9.6 2.972 0.003
BMI (kg/m2, $\bar{x}±s$) 24.63±2.70 23.00±2.39 25.82±2.26 -28.538 <0.001
吸烟[例(%)] 6.163 0.013
否 1917(83.7) 832(86.0) 1085(82.1)
是 373(16.3) 136(14.0) 237(17.9)
饮酒 [例(%)] 14.143 <0.001
否 1258(54.9) 576(59.5) 682(51.6)
是 1032(45.1) 392(40.5) 640(48.4)
TBil(μmol/L, $\bar{x}±s$) 13.62±5.44 13.41±5.14 13.78±5.65 -1.599 0.110
DBil(μmol/L, $\bar{x}±s$) 5.22±1.71 5.18±1.67 5.25±1.75 -0.860 0.390
γ-GT[U/L, M(Q1, Q3)] 22.50(17.00, 31.00) 20.00(15.00, 27.00) 25.00(18.00, 35.00) 10.657 <0.001
ALT[U/L, M(Q1, Q3)] 17.00(13.00, 23.00) 15.20(12.00, 20.08) 18.30(14.08, 24.60) 9.805 <0.001
AST[U/L, M(Q1, Q3)] 19.10(16.78, 23.00) 19.00(16.40, 22.00) 19.40(17.00, 23.00) 2.180 0.029
BUN(mmol/L, $\bar{x}±s$) 6.02±1.75 6.00±1.78 6.03±1.73 -0.453 0.651
Scr(μmol/L, $\bar{x}±s$) 84.60±21.17 83.28±19.74 85.57±22.12 -2.558 0.011
TSH[μU/mL, M(Q1, Q3)] 2.15(1.55, 3.13) 2.08(1.49, 3.11) 2.18(1.60, 3.16) 1.993 0.046
FT3(pmol/L, $\bar{x}±s$) 4.74±0.59 4.70±0.59 4.77±0.60 -2.864 0.004
FT4(pmol/L, $\bar{x}±s$) 16.36±2.46 16.46±2.41 16.28±2.49 1.662 0.097
高血压[例(%)] 20.622 <0.001
否 1407(61.4) 647(66.8) 760(57.5)
是 883(38.6) 321(33.2) 562(42.5)
糖尿病[例(%)] 49.805 <0.001
否 1977(86.3) 893(92.3) 1084(82.0)
是 313(13.7) 75(7.7) 238(18.0)
高尿酸血症[例(%)] 37.347 <0.001
否 1869(81.6) 846(87.4) 1023(77.4)
是 421(18.4) 122(12.6) 299(22.6)
高TC血症[例(%)] 2.965 0.085
否 2163(94.5) 905(93.5) 1258(95.2)
是 127(5.5) 63(6.5) 64(4.8)
高TG血症[例(%)] 151.039 <0.001
否 1744(76.2) 861(88.9) 883(66.8)
是 546(23.8) 107(11.1) 439(33.2)
高LDL-C血症[例(%)] 1.688 0.194
否 1940(84.7) 809(83.6) 1131(85.6)
是 350(15.3) 159(16.4) 191(14.4)
低HDL-C血症[例(%)] 61.828 <0.001
否 1946(85.0) 889(91.8) 1057(80.0)
是 344(15.0) 79(8.2) 265(20.0)
颈动脉硬化[例(%)] 3.360 0.067
否 449(19.6) 207(21.4) 242(18.3)
是 1841(80.4) 761(78.6) 1080(81.7)
甲状腺结节[例(%)] 6.956 0.008
否 423(18.5) 203(21.0) 220(16.6)
是 1867(81.5) 765(79.0) 1102(83.4)
胆系结石[例(%)] 6.852 0.009
否 1859(81.2) 810(83.7) 1049(79.3)
是 431(18.8) 158(16.3) 273(20.7)
TyG指数 8.67±0.49 8.47±0.43 8.83±0.48 18.877 <0.001
TyG-BMI 214.00±29.09 194.99±24.61 227.92±23.74 32.291 <0.001
), ArticleFig(id=1199711035113439363, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, language=EN, label=Tab.2, caption=

Comparison of MAFLD prevalence among elderly men in different TyG index and TyG-BMI subgroups [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
亚组

非MAFLD组
(n=968)

MAFLD组
(n=1322)

 χ2 P
TyG指数 297.540 <0.001
Q1 381(39.4) 191(14.4)
Q2 270(27.9) 297(22.5)
Q3 218(22.5) 359(27.2)
Q4 99(10.2) 475(35.9)
TyG-BMI 737.276 <0.001
Q1 485(50.1) 87(6.6)
Q2 278(28.7) 295(22.3)
Q3 145(15.0) 428(32.4)
Q4 60(6.2) 512(38.7)
), ArticleFig(id=1199711035197325446, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, language=CN, label=表2, caption=

不同TyG指数及TyG-BMI亚组老年男性MAFLD患病率比较[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
亚组

非MAFLD组
(n=968)

MAFLD组
(n=1322)

 χ2 P
TyG指数 297.540 <0.001
Q1 381(39.4) 191(14.4)
Q2 270(27.9) 297(22.5)
Q3 218(22.5) 359(27.2)
Q4 99(10.2) 475(35.9)
TyG-BMI 737.276 <0.001
Q1 485(50.1) 87(6.6)
Q2 278(28.7) 295(22.3)
Q3 145(15.0) 428(32.4)
Q4 60(6.2) 512(38.7)
), ArticleFig(id=1199711035281211530, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, language=EN, label=Tab.3, caption=

Association between TyG index and TyG-BMI and MAFLD in the elderly men

, figureFileSmall=null, figureFileBig=null, tableContent=
亚组 模型1 模型2 模型3
OR (95%CI) P OR (95%CI) P OR (95%CI) P
TyG指数
Q1 1 1 1
Q2 2.194(1.727~2.788) <0.001 1.755(1.325~2.324) <0.001 1.667(1.257~2.236) <0.001
Q3 3.285(2.579~4.184) <0.001 2.285(1.716~3.042) <0.001 2.004(1.482~2.710) <0.001
Q4 9.571(7.251~12.634) <0.001 7.427(5.389~10.237) <0.001 5.420(3.266~8.995) <0.001
趋势性检验P值 <0.001 <0.001 <0.001
TyG-BMI
Q1 1 1 1
Q2 5.916(4.467~7.834) <0.001 3.494(2.511~4.862) <0.001 2.215(1.549~3.167) <0.001
Q3 16.455(12.241~22.121) <0.001 6.746(4.445~10.239) <0.001 2.809(1.723~4.580) <0.001
Q4 47.571(33.470~67.612) <0.001 12.899(7.426~22.407) <0.001 2.513(1.253~5.040) 0.009
趋势性检验P值 <0.001 <0.001 0.004
), ArticleFig(id=1199711035377680526, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, language=CN, label=表3, caption=

TyG指数及TyG-BMI与老年男性MAFLD患病的相关性

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亚组 模型1 模型2 模型3
OR (95%CI) P OR (95%CI) P OR (95%CI) P
TyG指数
Q1 1 1 1
Q2 2.194(1.727~2.788) <0.001 1.755(1.325~2.324) <0.001 1.667(1.257~2.236) <0.001
Q3 3.285(2.579~4.184) <0.001 2.285(1.716~3.042) <0.001 2.004(1.482~2.710) <0.001
Q4 9.571(7.251~12.634) <0.001 7.427(5.389~10.237) <0.001 5.420(3.266~8.995) <0.001
趋势性检验P值 <0.001 <0.001 <0.001
TyG-BMI
Q1 1 1 1
Q2 5.916(4.467~7.834) <0.001 3.494(2.511~4.862) <0.001 2.215(1.549~3.167) <0.001
Q3 16.455(12.241~22.121) <0.001 6.746(4.445~10.239) <0.001 2.809(1.723~4.580) <0.001
Q4 47.571(33.470~67.612) <0.001 12.899(7.426~22.407) <0.001 2.513(1.253~5.040) 0.009
趋势性检验P值 <0.001 <0.001 0.004
), ArticleFig(id=1199711035461566610, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, language=EN, label=Tab.4, caption=

Predictive value of TyG index and TyG-BMI for MAFLD in the elderly men

, figureFileSmall=null, figureFileBig=null, tableContent=
指数 AUC 95%CI 准确率(%) 敏感度(%) 特异度(%) 阳性预测值(%) 阴性预测值(%)
TyG指数 0.717 0.696~0.738 65 64 67 73 58
TyG-BMI 0.840 0.823~0.856 78 85 68 79 77
), ArticleFig(id=1199711035549646998, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, language=CN, label=表4, caption=

TyG指数及TyG-BMI对老年男性MAFLD的预测价值

, figureFileSmall=null, figureFileBig=null, tableContent=
指数 AUC 95%CI 准确率(%) 敏感度(%) 特异度(%) 阳性预测值(%) 阴性预测值(%)
TyG指数 0.717 0.696~0.738 65 64 67 73 58
TyG-BMI 0.840 0.823~0.856 78 85 68 79 77
), ArticleFig(id=1199711035641921688, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, language=EN, label=Tab.5, caption=

Predictive value of TyG index and TyG-BMI for MAFLD in the elderly men without hyperlipidemia or diabetes

, figureFileSmall=null, figureFileBig=null, tableContent=
指数 AUC 95%CI 准确率(%) 敏感度(%) 特异度(%) 阳性预测值(%) 阴性预测值(%)
TyG指数 0.653 0.622~0.684 63 66 61 60 67
TyG-BMI 0.840 0.818~0.862 77 82 73 73 82
), ArticleFig(id=1199711035767750813, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199703042930078048, language=CN, label=表5, caption=

TyG指数及TyG-BMI在无高脂血症及糖尿病的老年男性中对MAFLD的预测价值

, figureFileSmall=null, figureFileBig=null, tableContent=
指数 AUC 95%CI 准确率(%) 敏感度(%) 特异度(%) 阳性预测值(%) 阴性预测值(%)
TyG指数 0.653 0.622~0.684 63 66 61 60 67
TyG-BMI 0.840 0.818~0.862 77 82 73 73 82
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三酰甘油-葡萄糖指数及其衍生指数与老年男性代谢相关脂肪性肝病的相关性分析
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康娟 1 , 刘文徽 2 , 常青 2 , 庄颖洁 2, *
解放军医学杂志 | 临床研究 2023,48(11): 1344-1352
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解放军医学杂志 | 临床研究 2023, 48(11): 1344-1352
三酰甘油-葡萄糖指数及其衍生指数与老年男性代谢相关脂肪性肝病的相关性分析
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康娟1, 刘文徽2, 常青2, 庄颖洁2, *
作者信息
  • 1解放军总医院第二医学中心门诊部急诊医学科/国家老年疾病临床研究中心，北京 100853
  • 2解放军总医院第二医学中心消化内科/国家老年疾病临床医学研究中心，北京 100853

    • 康娟，医学学士，主要从事慢性肝病方面的临床研究

通讯作者:

庄颖洁，E-mail：
Association between triglyceride glucose index and its related derivative index and metabolic associated fatty liver disease in the elderly men
Juan Kang1, Wen-Hui Liu2, Qing Chang2, Ying-Jie Zhuang2, *
Affiliations
  • 1Department of Emergency Medicine, Outpatient Department of the Second Medical Center/National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
  • 2Department of Gastroenterology, the Second Medical Center/National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
出版时间: 2023-11-28 doi: 10.11855/j.issn.0577-7402.0544.2023.1012
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摘要
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目的 探讨三酰甘油-葡萄糖(TyG)指数及其衍生指数三酰甘油-葡萄糖-体重指数(TyG-BMI)与老年男性人群代谢相关脂肪性肝病(MAFLD)患病风险之间的相关性。方法 选取2021年1-12月于解放军总医院第二医学中心门诊行年度体检的2290例老年男性，分为MAFLD组(n=1322)与非MAFLD组(n=968)。筛选MAFLD患病的混杂因素，采用多因素logistic回归分析TyG指数及TyG-BMI与MAFLD患病风险的相关性，并绘制受试者工作特征(ROC)曲线探讨其对老年男性MAFLD患病风险的预测价值。结果 2290例体检者年龄(74.3±10.1)岁，体重指数(BMI)为(24.63±2.70) kg/m2。MAFLD组BMI、γ-谷氨酰氨基转移酶(γ-GT)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、血肌酐(Scr)、促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)、吸烟、饮酒率，以及高血压、糖尿病、高尿酸血症、高甘油三酯(TG)血症、低高密度脂蛋白胆固醇(HDL-C)血症、甲状腺结节、胆系结石等的患病率明显高于非MAFLD组(P<0.05)，年龄低于非MAFLD组(P=0.003)。调整混杂因素后，多因素logistic回归分析显示，按TyG指数四分位数分组的Q2组、Q3组、Q4组患MAFLD的风险分别是Q1组的1.667倍(95%CI 1.257~2.236，P<0.001)、2.004倍(95%CI 1.482~2.710，P<0.001)、5.420倍(95%CI 3.266~8.995，P<0.001)；按TyG-BMI四分位数分组的Q2组、Q3组、Q4组患MAFLD的风险分别是Q1组的2.215倍(95%CI 1.549~3.167，P<0.001)、2.809倍(95%CI 1.723~4.580，P<0.001)、2.513倍(95%CI 1.253~5.040，P=0.009)。TyG指数及TyG-BMI预测老年男性MAFLD的ROC曲线下面积(AUC)分别为0.717(95%CI 0.696~0.738)、0.840(95%CI 0.823~0.856)，最佳截断值分别为8.63、205.20；在无高脂血症及糖尿病的老年男性中，TyG指数与TyG-BMI预测MAFLD的AUC分别为0.653(95%CI 0.622~0.684)、0.840(95%CI 0.818~0.862)，最佳截断值分别为8.42、202.66。TyG-BMI预测MAFLD的AUC、准确率、特异度、敏感度、阳性预测值、阴性预测值均高于TyG指数。结论 TyG指数及TyG-BMI高水平状态与老年男性MAFLD患病风险升高相关。TyG指数及TyG-BMI对老年男性MAFLD患病均有一定的预测价值，而TyG-BMI较TyG指数的预测价值更优。

非酒精性脂肪性肝病  /  三酰甘油  /  葡萄糖  /  体重指数  /  ROC曲线

Objective To explore the association between triglyceride glucose (TyG) index and TyG-body mass index (TyG-BMI) and the prevalence of metabolic associated fatty liver disease (MAFLD) in the elderly men. Methods Totally 2290 elderly men were selected from January to December in 2021 in the Second Medical Center of Chinese PLA General Hospital, and divided into MAFLD group (n=1322) and non-MAFLD group (n=968). Multivariate logistic regression was used to analyze the association between TyG index, TyG-BMI and MAFLD. The receiver operating characteristic (ROC) curve was drawn to explore the predictive value of TyG index and TyG-BMI with MAFLD in the elderly men. Results Two thousand two hundred and ninety elderly men were (74.3±10.1) years old, and an average BMI of (24.63±2.70) kg/m2. BMI, γ‑glutamyl transaminase (γ‑GT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine (Scr), thyroid stimulating hormone (TSH), free triiodothyronine (FT3), the rate of smoking and drinking, and the prevalence of hypertension, diabetes, hyperuricemia, high triglyceride (TG), low high density lipoprotein cholesterol (HDL-C), hyperuricemia, thyroid nodules and cholelithiasis were all significantly higher in non-MAFLD group than those in MAFLD group (P<0.05), while the age of MAFLD group was lower than that of non-MAFLD group (P=0.003). Multivariate logistic regression analysis showed that the risk of MAFLD in patients of TyG quartile groups Q2, Q3, Q4 was 1.667 (95%CI 1.257-2.236, P<0.001), 2.004 (95%CI 1.482-2.710, P<0.001) and 5.420 (95%CI 3.266-8.995, P<0.001) times higher than that of TyG Q1, respectively. The risk of MAFLD in patients of TyG-BMI Q2, Q3, Q4 was 2.215 (95%CI 1.549-3.167, P<0.001), 2.809 (95%CI 1.723-4.580, P<0.001) and 2.513 (95%CI 1.253-5.040, P=0.009) times higher than that of TyG-BMI Q1, respectively. The ROC curve showed that areas under the curve (AUC) of MAFLD predicted by TyG index and TyG-BMI were 0.717 (95%CI 0.696-0.738) and 0.840 (95%CI 0.823-0.856), and the best cut-off values were 8.63 and 205.20, respectively. Moreover, the ROC curve showed that AUC of MAFLD in the elderly men without hyperlipidemia or diabetes predicted by TyG index and TyG-BMI were 0.653 (95%CI 0.622-0.684) and 0.840 (95%CI 0.818-0.862), and the best cut-off values were 8.42 and 202.66, respectively. In addition, AUC, accuracy, specificity, sensitivity, positive predictive value and negative predictive value predicted by TyG-BMI were higher than those by TyG index. Conclusions TyG index and TyG-BMI are significantly associated with MAFLD in the elderly men. Both TyG index and TyG-BMI have certain predictive value for the prevalence of MAFLD in the elderly men, and TyG-BMI may be better.

non-alcoholic fatty liver disease  /  triacylglycerol  /  glucose  /  body mass index  /  receiver operating characteristic curve
康娟, 刘文徽, 常青, 庄颖洁. 三酰甘油-葡萄糖指数及其衍生指数与老年男性代谢相关脂肪性肝病的相关性分析. 解放军医学杂志, 2023 , 48 (11) : 1344 -1352 . DOI: 10.11855/j.issn.0577-7402.0544.2023.1012
Juan Kang, Wen-Hui Liu, Qing Chang, Ying-Jie Zhuang. Association between triglyceride glucose index and its related derivative index and metabolic associated fatty liver disease in the elderly men[J]. Medical Journal of Chinese People’s Liberation Army, 2023 , 48 (11) : 1344 -1352 . DOI: 10.11855/j.issn.0577-7402.0544.2023.1012
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代谢相关脂肪性肝病(metabolic associated fatty liver disease，MAFLD)曾用名为非酒精性脂肪性肝病(non-alcoholic fatty liver disease，NAFLD)，已经成为最流行的慢性肝脏疾病之一[1-2]，影响着全球至少四分之一的成年人口[3]。随着生活方式的改变，近年来MAFLD的患病率呈明显上升趋势[4]。研究发现，MAFLD已逐渐成为肝硬化、终末期肝病及原发性肝癌的主要原因之一，且已成为公共医疗保健的重大负担[5]。
近年来，三酰甘油-葡萄糖(triglyceride-glucose，TyG)指数及其衍生指数作为胰岛素抵抗(insulin resistance，IR)的理想替代指标逐渐兴起[6-9]。与胰岛素抵抗指数(homeostasis model assessment of insulin resistance，HOMA-IR)[10]比较，TyG能以更简单、经济的方式确定IR[11-12]。既往研究发现，TyG指数与2型糖尿病[7,13-14]、高血压[15]、冠状动脉疾病[16-18]有一定关联。研究发现，MAFLD/NAFLD的发病与IR密切相关[19]。另外，Er等[20]研究发现，应用TyG指数与体重指数(body mass index，BMI)的组合可以同时反映血脂、血糖及BMI等关键临床指标的信息，且比单独的TyG指数更能反映IR的程度。本研究探讨老年男性人群中TyG指数及其衍生指数三酰甘油-葡萄糖-体重指数(triglyceride-glucose-body mass index，TyG-BMI)与MAFLD患病之间的相关性，并比较TyG指数及TyG-BMI对老年男性MAFLD患病风险的预测价值。
1 资料与方法
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1.1 研究对象
选择2021年1-12月于解放军总医院第二医学中心门诊行年度体检的2290例老年男性。年龄(74.3±10.1)岁，BMI(24.63±2.70) kg/m2。纳入标准：(1)男性；(2)年龄≥60岁；(3)体检人群完成腹部超声或CT等影像学检查。排除标准：(1)患有原发性肝癌、胆管细胞癌及巨大肝囊肿等重大肝脏疾病；(2)重要数据缺失；(3)无法配合本研究。本研究获解放军总医院医学伦理委员会审批(S2023-213-01)。
1.2 诊断标准
MAFLD的诊断根据《2020 APASL代谢相关脂肪性肝病临床诊疗指南》[21]，在明确肝脏脂肪变性基础上同时合并超重、肥胖、2型糖尿病或代谢功能障碍即可诊断MAFLD。代谢功能障碍为至少存在以下两项代谢风险异常：(1)腰围：男性≥90 cm，女性≥80 cm；(2)血压≥130/85 mmHg(1 mmHg=0.133 kPa)或正在使用降压药物治疗；(3)三酰甘油(triglyceride，TG)≥1.70 mmol/L或正在使用降脂药物治疗；(4)高密度脂蛋白胆固醇(high density lipoprotein cholesterol，HDL-C)：男性<1.0 mmol/L，女性<1.3 mmol/L或正在使用降脂药物治疗；(5)空腹血糖5.6~6.9 mmol/L或餐后2 h血糖7.8~11.0 mmol/L或糖化血红蛋白(hemoglobin A1c，HbA1c)5.7%~6.4%；(6)HOMA-IR≥2.5；(7)超敏C反应蛋白>2 mg/L。由于缺乏胰岛素水平数据，因此本研究只考虑了其中6项代谢因素。另外，本研究中对于肝脏脂肪变性的诊断依赖于影像学依据，其中完全依赖超声诊断的962例，完全依赖CT诊断的24例，同时依赖超声及CT诊断的336例。根据是否患有MAFLD，将2290例研究对象分为MAFLD组(1322例)与非MAFLD组(968例)。
1.3 研究方法
收集研究对象的临床资料包括年龄、性别、身高、体重、BMI、吸烟、饮酒、有无合并高血压、糖尿病、颈动脉硬化、甲状腺结节、胆系结石及血生化指标等。禁食至少8 h后抽取受试者静脉血，检测的血生化指标主要包括血肌酐(serum creatinine，Scr)、尿素氮(blood urea nitrogen，BUN)、总胆固醇(total cholesterol，TC)、TG、HDL-C、低密度脂蛋白胆固醇(low density lipoprotein cholesterol，LDL-C)、谷草转氨酶(aspartate aminotransferase，AST)、谷丙转氨酶(alanine aminotransferase，ALT)、γ-谷氨酰氨基转移酶(γ-glutamyl transpeptidase，γ-GT)、总胆红素(total bilirubin，TBil)、直接胆红素(direct bilirubin，DBil)、空腹血糖(fast blood glucose，FBG)、HbA1c、促甲状腺激素(thyroid stimulating hormone，TSH)、游离三碘甲腺原氨酸(free triiodothyronine，FT3)、游离甲状腺素(free thyroxine，FT4)等。高血压、糖尿病、血脂异常、高尿酸血症等疾病分别根据相关指南进行诊断[22-25]。TyG指数及TyG-BMI的计算公式[26]：TyG=ln[TG(mg/dl)×FBG(mg/dl)/2]；TyG-BMI=TyG×BMI；BMI=体重(kg)/身高(m)2。基线TyG指数根据四分位数分组：Q1组，TyG指数≤8.33；Q2组，8.33<TyG指数≤8.64；Q3组，8.64<TyG指数≤8.99；Q4组，TyG指数>8.99。基线TyG-BMI根据四分位数分组：Q1组，TyG-BMI≤195.47；Q2组，195.47<TyG-BMI≤213.95；Q3组，213.95<TyG-BMI≤232.36；Q4组，TyG-BMI>232.36。
采用二元logistic回归模型分析TyG指数及TyG-BMI与MAFLD患病风险的相关性，采用多因素分析调整混杂因素，并将TyG指数及TyG-BMI四分位数分组赋值后纳入logistic回归模型进行线性趋势检验。建立受试者工作特征(receiver operating characteristic，ROC)曲线，探讨TyG指数及TyG-BMI对老年男性患MAFLD的预测价值。根据约登指数(即敏感度+特异度-1)最大值确定最佳截断值，并采用Delong test检验计算曲线下面积(area under the curve，AUC)差异。
1.4 统计学处理
采用SPSS 26.0及R4.2.2软件进行统计学分析。符合正态分布的计量资料以$\bar{x}±s$表示，组间比较采用独立样本t检验；非正态分布的计量资料以M(Q1，Q3)表示，组间比较采用Mann-Whitney U检验。计数资料以例(%)表示，组间比较采用Pearson χ2检验或Fisher确切概率法检验。P<0.05为差异有统计学意义。
2 结果
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2.1 非MAFLD组与MAFLD组临床资料比较
与非MAFLD组比较，MAFLD组年龄小(P<0.05)，BMI、γ-GT、ALT、AST、Scr、TSH、FT3水平明显升高(P<0.05)，吸烟、饮酒率及高血压、糖尿病、高尿酸血症、高TG血症、低HDL-C血症、甲状腺结节、胆系结石患病率也明显增高(P<0.05)，但两组TBil、DBil、BUN、FT4水平及高TC血症、高LDL-C血症及颈动脉硬化患病率比较，差异均无统计学意义(P>0.05，表1)。
2.2 不同亚组老年男性MAFLD患病情况比较
TyG指数Q4组中MAFLD的患病率(35.9%)，明显高于Q1组(14.4%)、Q2组(22.5%)及Q3组(27.2%)，差异有统计学意义(P<0.001)。TyG-BMI Q4组中MAFLD的患病率为(38.7%)，明显高于Q1组(6.6%)、Q2组(22.3%)及Q3组(32.4%)，差异有统计学意义(P<0.001，表2)。
2.3 TyG指数及TyG-BMI与老年男性MAFLD患病的相关性
分别以TyG指数及TyG-BMI为自变量，以MAFLD为因变量，采用logistic回归模型分析TyG指数及TyG-BMI与老年男性MAFLD患病的关系。分别以TyG指数及TyG-BMI的第1个四分位组(Q1)作为参照。经模型3校正后，TyG指数Q2组患MAFLD风险是Q1组的1.667倍(95%CI 1.257~2.236，P<0.001)，TyG指数Q3组患MAFLD风险是Q1组的2.004倍(95%CI 1.482~2.710，P<0.001)，TyG指数Q4组患MAFLD风险是Q1组的5.420倍(95%CI 3.266~8.995，P<0.001)，且MAFLD患病风险随TyG指数四分位数增加而增加(趋势性检验P<0.001)。经模型3校正后，TyG-BMI Q2组患MAFLD风险是Q1组的2.215倍(95%CI 1.549~3.167，P<0.001)，TyG-BMI Q3组患MAFLD风险是Q1组的2.809倍(95%CI 1.723~4.580，P<0.001)，TyG-BMI Q4组患MAFLD风险是Q1组的2.513倍(95%CI 1.253~5.040，P=0.009)，且MAFLD患病风险随TyG-BMI四分位数增加而增加(趋势性检验P=0.004，表3)。
2.4 TyG指数及TyG-BMI对老年男性患MAFLD的预测价值
TyG指数及TyG-BMI预测老年男性患MAFLD的AUC分别为0.717(95%CI 0.696~0.738)、0.840(95%CI 0.823~0.856)，最佳截断值分别为8.63、205.20(图1)。TyG-BMI预测MAFLD的AUC、准确率、特异度、敏感度、阳性预测值、阴性预测值均优于TyG指数(表4)。
2.5 TyG指数及TyG-BMI在无高脂血症及糖尿病老年男性中对MAFLD患病风险的预测价值
因TyG指数及TyG-BMI是基于三酰甘油及葡萄糖计算，故本研究进一步在无高脂血症及糖尿病的老年男性人群中分析TyG指数及TyG-BMI对MAFLD患病风险的预测价值。TyG指数及TyG-BMI的AUC分别为0.653(95%CI 0.622~0.684)、0.840(95%CI 0.818~0.862)，最佳截断值分别为8.42、202.66(图2)。TyG-BMI预测MAFLD的AUC、准确率、特异度、敏感度、阳性预测值、阴性预测值仍优于TyG指数(表5)。
3 讨论
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MAFLD作为全球流行的慢性肝病，随着社会老龄化进程的加快，已经成为影响老年人健康的重要问题之一[27-28]。目前对TyG指数及其相关衍生指数TyG-BMI与老年人群MAFLD患病风险的相关性报道较少。本研究以2290例老年男性为研究对象，探讨TyG指数及TyG-BMI与MAFLD患病之间的相关性，并探究该指数对MAFLD患病风险的预测价值。结果发现，高水平的TyG指数及TyG-BMI均与老年男性MAFLD患病风险增加明显相关，对老年男性MAFLD患病风险存在一定的预测价值，且TyG-BMI较TyG指数预测价值更优。
本研究通过logistic回归分析发现，在调整各种混杂因素后，高水平的TyG指数及TyG-BMI均与老年男性MAFLD患病风险增加独立相关，其机制可能与能量过剩、IR抑制脂肪组织分解、增加肝脏新生脂肪生成导致游离脂肪酸增加，从而使三酰甘油合成增多[29-32]，以及高甘油三酯血症促进游离脂肪酸向肝脏的运输，并增加肝脏葡萄糖输出有关[33-35]。
本研究ROC曲线分析显示，TyG指数及TyG-BMI对于老年男性MAFLD患病均有良好的预测价值，其AUC分别为0.717、0.840。本研究进一步分析发现，在无高脂血症及糖尿病的老年男性人群中，TyG指数及TyG-BMI对MAFLD患病预测的AUC分别为0.653、0.840，与老年男性全人群相似，尤其是TyG-BMI的结果是相对稳定的。此与Xue等[36]基于NHANES数据库的研究结果相似，该研究中TyG-BMI预测MAFLD的AUC为0.822。Hu等[37]发现，TyG-BMI在训练集及验证集中预测NAFLD的AUC分别为0.888、0.884，稍高于本研究，可能是其研究训练集排除了2型糖尿病、服用任何药物及饮酒人群，验证集受试者均为LDL-C正常范围的非肥胖患者，与本研究人群的基线差异较大。Yang等[38]对中国西南部7968例成年人研究发现，其TyG指数及TyG-BMI预测MAFLD的AUC(分别为0.795、0.884)高于本研究。原因可能是该研究人群年龄仅(39.6±11.0)岁，明显低于本研究，而年龄对胰岛素的敏感度影响较大。Song等[35]发现，TyG指数及TyG-BMI预测青少年NAFLD患病的最佳截断值为8.466、201.617。Zhang等[39]发现20岁以上人群TyG指数预测NAFLD的临界值为8.5。Guo等[40]发现成人TyG指数预测NAFLD的临界值为8.7。本研究中TyG指数及TyG-BMI预测老年男性MAFLD患病的最佳截断值分别为8.63、205.20，与上述研究结果基本一致。
肥胖是MAFLD发生及发展的重要因素[41]，研究表明BMI与MAFLD密切相关[42-43]。因此，本研究发现TyG-BMI比单独应用TyG指数预测MAFLD的效能更优不难理解。Wang等[44]也发现，TyG-BMI预测NAFLD的效能优于TyG指数，尤其是在年轻人、中年人及非肥胖人群中；Kim等[45]发现，韩国普通人群TyG-BMI预测NAFLD的效能优于TyG指数及HOMA-IR；Sheng等[46]在中国普通人群中及Song等[47]在韩国青少年中的横断面研究也得出了一致的结果；Li等[48]在中国2型糖尿病人群中也得出了相似的结果。
综上所述，TyG指数及TyG-BMI高水平状态与老年男性MAFLD患病风险增高相关。TyG指数及TyG-BMI对老年男性MAFLD患病均有一定的预测价值，而TyG-BMI较TyG指数预测价值更优。监测TyG指数及TyG-BMI有助于识别老年男性群体健康中原本被忽视的潜在风险，为MAFLD的早期防治提供了新思路。但本研究仍有一定的局限性：(1)本研究为单中心回顾性研究，代表性不足，且无法确定因果关系；(2)肝脏脂肪变性均依赖超声、CT等影像学结果，无病理学活检证据，虽然影像学检查在诊断肝脏脂肪变性方面也显示出较高的敏感度及特异度，但当肝脏脂肪变性程度<20%或在受试者BMI>40 kg/m2时，超声检测效能明显降低，CT也多用于中、重度肝脂肪变性[49]；(3)未能收集到臀围等数据，不能评估其他TyG指数相关衍生指标与老年男性MAFLD患病的相关性。今后仍需前瞻性、多中心临床研究以进一步探讨。
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2023年第48卷第11期
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doi: 10.11855/j.issn.0577-7402.0544.2023.1012
  • 接收时间：2023-04-17
  • 首发时间：2025-11-24
  • 出版时间：2023-11-28
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  • 收稿日期：2023-04-17
  • 录用日期：2023-08-16
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    1解放军总医院第二医学中心门诊部急诊医学科/国家老年疾病临床研究中心，北京 100853
    2解放军总医院第二医学中心消化内科/国家老年疾病临床医学研究中心，北京 100853

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