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Article(id=1324077444537398146, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077443828560770, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202510302, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1761062400000, receivedDateStr=2025-10-22, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614262947, onlineDateStr=2026-11-02, pubDate=1775750400000, pubDateStr=2026-04-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614262947, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614262947, creator=13701087609, updateTime=1793614262947, updator=13701087609, issue=Issue{id=1324077443828560770, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='7', pageStart='1153', pageEnd='1344', issueExtLink='null', onlineDate='null', pubDate='1775750400000', pubDateStr='2026-04-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614262778, creator='13701087609', updateTime=1793614352085, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324077818509918661, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077443828560770, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324077818509918662, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077443828560770, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1213, endPage=1219, ext={EN=ArticleExt(id=1324077444747113347, articleId=1324077444537398146, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between TyG-BRI and stroke in middle-aged and older adults: a longitudinal study based on CHARLS, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the association between trigyceride glucose index - body roundness index (TyG-BRI) and the risk of stroke in middle-aged and older adults using the CHARLS database.

Methods

This study conducted a longitudinal study using CHARLS data from 2011 to 2020. The TyG index was calculated from baseline fasting blood glucose and triglyceride levels. TyG-BRI was developed by integrating the TyG index with baseline waist circumference and height. Stroke was identified through follow-up questionnaires. After imputing missing data using MICE, we analyzed the data by stratifying TyG-BRI according to quartile levels and conducted Kaplan-Meier survival curve analysis. Meanwhile, a multivariable Cox proportional hazards regression model was used to assess the association between different TyG-BRI levels and the risk of stroke. Restricted cubic spline (RCS) analysis was employed to examine the dose-response relationship between TyG-BRI and the incidence of stroke. Finally, subgroup analyses and interaction tests were performed to explore the heterogeneity of the association between TyG-BRI and stroke among different populations.

Results

A total of 7 709 individuals were included in the longitudinal study throughout the entire follow-up period, and 536 developed stroke. Both Cox regression and Kaplan-Meier analyses showed that higher TyG-BRI levels were associated with increased stroke risk. Using the first quartile (Q1) as reference, the fully adjusted model (Model 3) showed significantly elevated risks for Q2 (HR=1.39, 95% CI: 1.04-1.86), Q3 (HR=1.70, 95% CI: 1.28-2.27), and Q4 (HR=1.75, 95% CI: 1.28-2.40). RCS analysis revealed a linear relationship between TyG-BRI and stroke risk with an overall positive trend. Subgroup analyses did not identify any factors independently associated with stroke. Sensitivity analyses confirmed the robustness of these findings.

Conclusion

TyG-BRI shows potential as a useful indicator for early detection and prevention in stroke risk management.

, authors=Jiao ZHANG, Wei-hui YANG, Dan SUN, Li-na MEI, authorsList=Jiao ZHANG, Wei-hui YANG, Dan SUN, Li-na MEI, authorCompany=null, correspAuthors=Li-na MEI, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324077448299688852, articleId=1324077444537398146, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=基于CHARLS数据库评估新型综合指标TyG-BRI与中老年人脑卒中风险的纵向关联, columnId=1228016567632462653, journalTitle=现代预防医学, columnName=流行病与统计方法, runingTitle=null, highlight=null, articleAbstract=
目的

利用中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）数据库，研究甘油三酯-葡萄糖指数（trigyceride glucose index，TyG）-身体圆度指数（body roundness index，BRI）与中老年人脑卒中风险的相关性。

方法

本研究基于2011—2020年CHARLS数据进行纵向研究。TyG指数通过基线测量的空腹血糖与甘油三酯计算得出，TyG-BRI则在TyG基础上进一步结合基线腰围和身高所构建。脑卒中的发生通过问卷调查方式进行判断。此次研究对缺失数据采用MICE插补后进行分析，将TyG-BRI按四分位数水平分层，进行Kaplan-Meier曲线生存分析。同时通过多因素Cox比例风险回归模型，评估不同TyG-BRI水平与脑卒中风险之间的关联。采用限制性立方样条（restricted cubic splines，RCS）分析TyG-BRI与脑卒中发生风险之间的剂量反应关系。最后，通过亚组分析和交互作用检验，探讨TyG-BRI与脑卒中关联在不同人群中的异质性。

结果

整个随访周期中，纳入纵向研究人数7 709人，其中536人随访期间确诊为脑卒中。Cox回归分析及Kaplan-Meier曲线均提示TyG-BRI水平与脑卒中风险正相关。以Q1组为参照，在模型3中，Q2、Q3、Q4组的风险均显著增加，其风险比与置信区间分别为：Q2组（HR=1.39，95%CI：1.04~1.86）、Q3组（HR=1.70，95%CI：1.28~2.27）、Q4组（HR=1.75，95%CI：1.28~2.40）。同时RCS曲线揭示了TyG-BRI与脑卒中之间线性关系，整体趋势为正相关。在亚组分析中，并未发现有与脑卒中独立相关的因素，敏感性分析也验证了上述结果的稳健性。

结论

TyG-BRI可在脑卒中风险管理的早期检测和预防中有重要的临床意义。

, authors=张姣, 杨伟慧, 孙丹, 梅丽娜, authorsList=张姣, 杨伟慧, 孙丹, 梅丽娜, authorCompany=null, correspAuthors=梅丽娜, authorNote=

张姣（1992—），女，硕士在读，主治医师，研究方向：内分泌与代谢

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梅丽娜，E-mail：
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Acta Diabetologica, 2025, 62(10): 1647-1657., articleTitle=Association between the triglyceride glucose-body roundness index and the incidence of cardiovascular disease among Chinese middle and old-aged adults: a nationwide prospective cohort study, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1324077448563930005, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077444537398146, xref=null, ext=[AuthorCompanyExt(id=1324077448584901526, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077444537398146, companyId=1324077448563930005, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Internal Medicine, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang 313000, China), AuthorCompanyExt(id=1324077448605873047, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077444537398146, companyId=1324077448563930005, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=湖州市妇幼保健院内科，浙江　湖州　313000)])], figs=[ArticleFig(id=1324077452498187190, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077444537398146, language=EN, label=Figure 1, caption=Comparison of stroke case number and cumulative incidence across TyG-BRI groups, figureFileSmall=wvQSMrhcVvV6EPq6vhqWhw==, figureFileBig=1tJpBVd0K4iYwtMq5TULjw==, tableContent=null), ArticleFig(id=1324077452582073271, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077444537398146, language=CN, label=图1, caption=各组TyG-BRI脑卒中发病人数和累积发生率比较, figureFileSmall=wvQSMrhcVvV6EPq6vhqWhw==, figureFileBig=1tJpBVd0K4iYwtMq5TULjw==, tableContent=null), ArticleFig(id=1324077452779205560, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077444537398146, language=EN, label=Figure 2, caption=Time-dependent ROC curves of TyG-BRI, BRI, and TyG for predicting new-onset stroke, figureFileSmall=LXf3y2OLeQ6R7GkvEETI0g==, figureFileBig=HgpiskWRsx3D/fgc5/EyLg==, tableContent=null), ArticleFig(id=1324077452888257465, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077444537398146, language=CN, label=图2, caption=TyG-BRI、BRI和TyG预测新发脑卒中的时间依赖性ROC曲线

注：3year、5year、7year、9year指随访的第3、5、7和9年；A为TyG-BRI；B为BRI；C为TyG。

, figureFileSmall=LXf3y2OLeQ6R7GkvEETI0g==, figureFileBig=HgpiskWRsx3D/fgc5/EyLg==, tableContent=null), ArticleFig(id=1324077452963754938, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077444537398146, language=EN, label=Figure 3, caption=Nonlinear associations of TyG-BRI with stroke incidence, figureFileSmall=93dFp3Hp2yYPNVuuzlkPgg==, figureFileBig=YHKj3n5tkxjQ0DSWXX/HVw==, tableContent=null), ArticleFig(id=1324077453043446715, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077444537398146, language=CN, label=图3, caption=TyG-BRI与脑卒中之间的非线性效应分析, figureFileSmall=93dFp3Hp2yYPNVuuzlkPgg==, figureFileBig=YHKj3n5tkxjQ0DSWXX/HVw==, tableContent=null), ArticleFig(id=1324077453123138492, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077444537398146, language=EN, label=Figure 4, caption=Subgroup analysis and interaction effect evaluation of the association between TyG-BRI and risk of new-onset stroke, figureFileSmall=SAYVQTB6SURC6sj02sLkjA==, figureFileBig=GyRmS2YSWm3kGNkd3JqxKg==, tableContent=null), ArticleFig(id=1324077453194441661, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077444537398146, language=CN, label=图4, caption=TyG-BRI与新发脑卒中之间的亚组分析及交互作用, figureFileSmall=SAYVQTB6SURC6sj02sLkjA==, figureFileBig=GyRmS2YSWm3kGNkd3JqxKg==, tableContent=null), ArticleFig(id=1324077453286716350, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077444537398146, language=EN, label=Table 1, caption=

Baseline characteristic of the study participants [(), n(%)]

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变量总计Q1组Q2组Q3组Q4组P值
n7 7091 9281 9271 9271 927
年龄（岁）59.16±9.4059.16±9.4558.66±9.2658.88±9.4259.92±9.45<0.001
性别
女性4 047（52.50）610（31.64）905（46.96）1 106（57.39）1 426（74.00）<0.001
男性3 662（47.50）1 318（68.36）1 022（53.04）821（42.61）501（26.00）
教育水平0.006
初中以下6 961（90.30）1 739（90.20）1 722（89.36）1 722（89.36）1 778（92.27）
初中以上748（9.70）189（9.80）205（10.64）205（10.64）149（7.73）
吸烟<0.001
否4 659（60.44）824（42.74）1 077（55.89）1 258（65.28）1 500（77.84）
是3 050（39.56）1 104（57.26）850（44.11）669（34.72）427（22.16）
饮酒<0.001
否5 091（66.04）1 085（56.28）1 192（61.86）1 331（69.07）1 483（76.96）
是2 618（33.96）843（43.72）735（38.14）596（30.93）444（23.04）
高血压<0.001
否6 118（79.36）1 734（89.94）1 646（85.42）1 490（77.32）1 248（64.76）
是1 591（20.64）194（10.06）281（14.58）437（22.68）679（35.24）
糖尿病<0.001
否7 357（95.43）1 895（98.29）1 878（97.46）1 826（94.76）1 758（91.23）
是352（4.57）33（1.71）49（2.54）101（5.24）169（8.77）
脑卒中<0.001
否7 173（93.05）1 848（95.85）1 811（93.98）1 773（92.01）1 741（90.35）
是536（6.95）80（4.15）116（6.02）154（7.99）186（9.65）
BRI4.19±1.332.68±0.433.62±0.324.51±0.425.95±0.90<0.001
TyG8.66±0.668.28±0.508.53±0.538.74±0.579.11±0.70<0.001
收缩压（mm Hg）129.95±21.23124.36±19.86127.11±19.86131.17±21.12137.16±21.83<0.001
舒张压（mm Hg）75.54±12.0872.64±11.6674.12±11.9076.39±11.8379.00±11.96<0.001
BMI（kg/m2）23.33±3.7320.01±2.1522.12±2.3824.11±2.4627.09±3.47<0.001
白细胞计数（109/L）6.28±2.246.12±1.916.25±3.076.24±1.836.51±1.88<0.001
MCV（fL）90.69±8.5891.36±9.3590.99±9.0190.52±8.2789.88±7.49<0.001
血小板计数（109/L）211.51±72.87208.03±73.31213.08±72.07209.19±71.66215.75±74.210.003
尿素氮（mg/dl*）15.77±4.5916.24±4.6415.84±4.8815.61±4.4315.40±4.37<0.001
血糖（mmol/L）6.09±2.015.63±1.315.87±1.666.11±1.886.74±2.72<0.001
肌酐（mg/dl*）0.78±0.240.80±0.180.79±0.230.78±0.330.76±0.19<0.001
总胆固醇（mg/dl*）193.59±38.00183.52±35.59191.06±35.94196.01±37.39203.76±40.04<0.001
甘油三酯（mmol/L）1.42±1.050.97±0.541.21±0.681.47±0.902.05±1.49<0.001
HDL（mmol/L）1.34±0.401.52±0.411.41±0.391.29±0.361.16±0.33<0.001
LDL（mmol/L）3.03±0.912.84±0.823.02±0.833.13±0.903.13±1.03<0.001
CRP（mg/L）2.67±7.502.56±8.602.60±8.292.67±7.522.83±5.090.699
HbA1c（%）5.25±0.805.10±0.565.16±0.685.26±0.795.50±1.03<0.001
尿酸（mg/dl*）4.46±1.254.39±1.204.38±1.224.48±1.304.57±1.26<0.001
血红蛋白（g/dl）14.36±2.2314.29±2.1514.34±2.2014.34±2.2914.47±2.280.084
), ArticleFig(id=1324077453362213823, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077444537398146, language=CN, label=表1, caption=

基线资料表[（），n（%）]

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变量总计Q1组Q2组Q3组Q4组P值
n7 7091 9281 9271 9271 927
年龄（岁）59.16±9.4059.16±9.4558.66±9.2658.88±9.4259.92±9.45<0.001
性别
女性4 047（52.50）610（31.64）905（46.96）1 106（57.39）1 426（74.00）<0.001
男性3 662（47.50）1 318（68.36）1 022（53.04）821（42.61）501（26.00）
教育水平0.006
初中以下6 961（90.30）1 739（90.20）1 722（89.36）1 722（89.36）1 778（92.27）
初中以上748（9.70）189（9.80）205（10.64）205（10.64）149（7.73）
吸烟<0.001
否4 659（60.44）824（42.74）1 077（55.89）1 258（65.28）1 500（77.84）
是3 050（39.56）1 104（57.26）850（44.11）669（34.72）427（22.16）
饮酒<0.001
否5 091（66.04）1 085（56.28）1 192（61.86）1 331（69.07）1 483（76.96）
是2 618（33.96）843（43.72）735（38.14）596（30.93）444（23.04）
高血压<0.001
否6 118（79.36）1 734（89.94）1 646（85.42）1 490（77.32）1 248（64.76）
是1 591（20.64）194（10.06）281（14.58）437（22.68）679（35.24）
糖尿病<0.001
否7 357（95.43）1 895（98.29）1 878（97.46）1 826（94.76）1 758（91.23）
是352（4.57）33（1.71）49（2.54）101（5.24）169（8.77）
脑卒中<0.001
否7 173（93.05）1 848（95.85）1 811（93.98）1 773（92.01）1 741（90.35）
是536（6.95）80（4.15）116（6.02）154（7.99）186（9.65）
BRI4.19±1.332.68±0.433.62±0.324.51±0.425.95±0.90<0.001
TyG8.66±0.668.28±0.508.53±0.538.74±0.579.11±0.70<0.001
收缩压（mm Hg）129.95±21.23124.36±19.86127.11±19.86131.17±21.12137.16±21.83<0.001
舒张压（mm Hg）75.54±12.0872.64±11.6674.12±11.9076.39±11.8379.00±11.96<0.001
BMI（kg/m2）23.33±3.7320.01±2.1522.12±2.3824.11±2.4627.09±3.47<0.001
白细胞计数（109/L）6.28±2.246.12±1.916.25±3.076.24±1.836.51±1.88<0.001
MCV（fL）90.69±8.5891.36±9.3590.99±9.0190.52±8.2789.88±7.49<0.001
血小板计数（109/L）211.51±72.87208.03±73.31213.08±72.07209.19±71.66215.75±74.210.003
尿素氮（mg/dl*）15.77±4.5916.24±4.6415.84±4.8815.61±4.4315.40±4.37<0.001
血糖（mmol/L）6.09±2.015.63±1.315.87±1.666.11±1.886.74±2.72<0.001
肌酐（mg/dl*）0.78±0.240.80±0.180.79±0.230.78±0.330.76±0.19<0.001
总胆固醇（mg/dl*）193.59±38.00183.52±35.59191.06±35.94196.01±37.39203.76±40.04<0.001
甘油三酯（mmol/L）1.42±1.050.97±0.541.21±0.681.47±0.902.05±1.49<0.001
HDL（mmol/L）1.34±0.401.52±0.411.41±0.391.29±0.361.16±0.33<0.001
LDL（mmol/L）3.03±0.912.84±0.823.02±0.833.13±0.903.13±1.03<0.001
CRP（mg/L）2.67±7.502.56±8.602.60±8.292.67±7.522.83±5.090.699
HbA1c（%）5.25±0.805.10±0.565.16±0.685.26±0.795.50±1.03<0.001
尿酸（mg/dl*）4.46±1.254.39±1.204.38±1.224.48±1.304.57±1.26<0.001
血红蛋白（g/dl）14.36±2.2314.29±2.1514.34±2.2014.34±2.2914.47±2.280.084
), ArticleFig(id=1324077453462877120, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077444537398146, language=EN, label=Table 2, caption=

Association between TyG-BRI and stroke in the Cox regression

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TyG-BRImodel1model2model3
HR（95%CI）P值HR（95%CI）P值HR（95%CI）P值
Q11.00（Reference）—1.00（Reference）—1.00（Reference）—
Q21.46（1.10~1.95）0.0091.51（1.13~2.01）0.0051.39（1.04~1.86）0.025
Q31.97（1.50~2.59）<0.0011.99（1.51~2.63）<0.0011.70（1.28~2.27）0.003
Q42.39（1.84~3.11）<0.0012.31（1.74~3.07）<0.0011.75（1.28~2.40）0.004
每增加1个标准差1.32（1.22~1.42）<0.0011.27（1.17~1.39）<0.0011.15（1.03~1.27）0.009
), ArticleFig(id=1324077453563540417, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077444537398146, language=CN, label=表2, caption=

TyG-BRI与脑卒中Cox回归模型

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TyG-BRImodel1model2model3
HR（95%CI）P值HR（95%CI）P值HR（95%CI）P值
Q11.00（Reference）—1.00（Reference）—1.00（Reference）—
Q21.46（1.10~1.95）0.0091.51（1.13~2.01）0.0051.39（1.04~1.86）0.025
Q31.97（1.50~2.59）<0.0011.99（1.51~2.63）<0.0011.70（1.28~2.27）0.003
Q42.39（1.84~3.11）<0.0012.31（1.74~3.07）<0.0011.75（1.28~2.40）0.004
每增加1个标准差1.32（1.22~1.42）<0.0011.27（1.17~1.39）<0.0011.15（1.03~1.27）0.009
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基于CHARLS数据库评估新型综合指标TyG-BRI与中老年人脑卒中风险的纵向关联
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张姣 , 杨伟慧 , 孙丹 , 梅丽娜
现代预防医学 | 流行病与统计方法 2026,53(7): 1213-1219
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现代预防医学 |流行病与统计方法 2026 , 53 (7) : 1213 -1219
基于CHARLS数据库评估新型综合指标TyG-BRI与中老年人脑卒中风险的纵向关联
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张姣（1992—），女，硕士在读，主治医师，研究方向：内分泌与代谢

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张姣（1992—），女，硕士在读，主治医师，研究方向：内分泌与代谢

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张姣, 杨伟慧, 孙丹, 梅丽娜
作者信息
  • 湖州市妇幼保健院内科，浙江　湖州　313000
通讯作者:
梅丽娜，E-mail：
作者简介:

张姣（1992—），女，硕士在读，主治医师，研究方向：内分泌与代谢

Association between TyG-BRI and stroke in middle-aged and older adults: a longitudinal study based on CHARLS
Jiao ZHANG, Wei-hui YANG, Dan SUN, Li-na MEI
Affiliations
  • Department of Internal Medicine, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang 313000, China
出版时间: 2026-04-10 doi: 10.20043/j.cnki.MPM.202510302
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摘要
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目的

利用中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）数据库，研究甘油三酯-葡萄糖指数（trigyceride glucose index，TyG）-身体圆度指数（body roundness index，BRI）与中老年人脑卒中风险的相关性。

方法

本研究基于2011—2020年CHARLS数据进行纵向研究。TyG指数通过基线测量的空腹血糖与甘油三酯计算得出，TyG-BRI则在TyG基础上进一步结合基线腰围和身高所构建。脑卒中的发生通过问卷调查方式进行判断。此次研究对缺失数据采用MICE插补后进行分析，将TyG-BRI按四分位数水平分层，进行Kaplan-Meier曲线生存分析。同时通过多因素Cox比例风险回归模型，评估不同TyG-BRI水平与脑卒中风险之间的关联。采用限制性立方样条（restricted cubic splines，RCS）分析TyG-BRI与脑卒中发生风险之间的剂量反应关系。最后，通过亚组分析和交互作用检验，探讨TyG-BRI与脑卒中关联在不同人群中的异质性。

结果

整个随访周期中，纳入纵向研究人数7 709人，其中536人随访期间确诊为脑卒中。Cox回归分析及Kaplan-Meier曲线均提示TyG-BRI水平与脑卒中风险正相关。以Q1组为参照，在模型3中，Q2、Q3、Q4组的风险均显著增加，其风险比与置信区间分别为：Q2组（HR=1.39，95%CI：1.04~1.86）、Q3组（HR=1.70，95%CI：1.28~2.27）、Q4组（HR=1.75，95%CI：1.28~2.40）。同时RCS曲线揭示了TyG-BRI与脑卒中之间线性关系，整体趋势为正相关。在亚组分析中，并未发现有与脑卒中独立相关的因素，敏感性分析也验证了上述结果的稳健性。

结论

TyG-BRI可在脑卒中风险管理的早期检测和预防中有重要的临床意义。

甘油三酯葡萄糖指数  /  身体圆度指数  /  脑卒中  /  纵向研究  /  中国健康与养老追踪调查
Objective

To investigate the association between trigyceride glucose index - body roundness index (TyG-BRI) and the risk of stroke in middle-aged and older adults using the CHARLS database.

Methods

This study conducted a longitudinal study using CHARLS data from 2011 to 2020. The TyG index was calculated from baseline fasting blood glucose and triglyceride levels. TyG-BRI was developed by integrating the TyG index with baseline waist circumference and height. Stroke was identified through follow-up questionnaires. After imputing missing data using MICE, we analyzed the data by stratifying TyG-BRI according to quartile levels and conducted Kaplan-Meier survival curve analysis. Meanwhile, a multivariable Cox proportional hazards regression model was used to assess the association between different TyG-BRI levels and the risk of stroke. Restricted cubic spline (RCS) analysis was employed to examine the dose-response relationship between TyG-BRI and the incidence of stroke. Finally, subgroup analyses and interaction tests were performed to explore the heterogeneity of the association between TyG-BRI and stroke among different populations.

Results

A total of 7 709 individuals were included in the longitudinal study throughout the entire follow-up period, and 536 developed stroke. Both Cox regression and Kaplan-Meier analyses showed that higher TyG-BRI levels were associated with increased stroke risk. Using the first quartile (Q1) as reference, the fully adjusted model (Model 3) showed significantly elevated risks for Q2 (HR=1.39, 95% CI: 1.04-1.86), Q3 (HR=1.70, 95% CI: 1.28-2.27), and Q4 (HR=1.75, 95% CI: 1.28-2.40). RCS analysis revealed a linear relationship between TyG-BRI and stroke risk with an overall positive trend. Subgroup analyses did not identify any factors independently associated with stroke. Sensitivity analyses confirmed the robustness of these findings.

Conclusion

TyG-BRI shows potential as a useful indicator for early detection and prevention in stroke risk management.

Triglyceride glucose index  /  Body roundness index  /  Stroke  /  Longitudinal study  /  China health and retirement longitudinal study
张姣, 杨伟慧, 孙丹, 梅丽娜. 基于CHARLS数据库评估新型综合指标TyG-BRI与中老年人脑卒中风险的纵向关联. 现代预防医学, 2026 , 53 (7) : 1213 -1219 . DOI: 10.20043/j.cnki.MPM.202510302
Jiao ZHANG, Wei-hui YANG, Dan SUN, Li-na MEI. Association between TyG-BRI and stroke in middle-aged and older adults: a longitudinal study based on CHARLS[J]. Modern Preventive Medicine, 2026 , 53 (7) : 1213 -1219 . DOI: 10.20043/j.cnki.MPM.202510302
正文
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2021年全球疾病负担（Global Burden of Disease Study，GBD）研究显示，全球脑卒中患病人数达9 380万，新发病例约1 190万，已成为全球第三大死因，占比10.7%，仅次于缺血性心脏病与新冠肺炎（COVID-19）[1]。我国2020年脑卒中现患人数约1 780万，当年新发病例约340万，因脑卒中及相关并发症死亡的人数约为230万，且中年人的分布比例逐渐增加[2-4]。高发病率、高致残率、高死亡率、高复发率和高经济负担为脑卒中的五大特点。胰岛素抵抗（insulin resistance，IR）、肥胖与心脑血管风险密切相关[4-5]。甘油三酯-葡萄糖指数（triglyceride glucose index，TyG）作为临床评估IR的实用工具，因其简单可靠，已逐步代替高胰岛素-正常血糖钳夹试验或稳态模型评估的胰岛素抵抗指数（homeostasis model assessment of insulin resistance，HOMA）-IR。此外肥胖，尤其是内脏脂肪型肥胖，可通过诱发内质网应激及慢性炎症反应等机制进一步加剧IR；反之，IR也可通过对脂质代谢的负面影响及促进能量蓄积，从而形成并加重肥胖状态[6]。身体圆度指数（body roundness index，BRI）是由Thomas提出的一种与腹部肥胖相关的新型人体测量指标，它整合了腰围和身高，比身体质量指数（body mass index，BMI）、腰围等传统指标更有效地反映体脂和内脏脂肪比例[7]。
TyG与BRI分别从代谢紊乱与体脂分布两个核心维度评估脑血管疾病风险，使用联合指标能够实现对个体脑卒中风险的更全面评估，尤其对内脏肥胖人群的识别具有重要筛查价值。目前国内临床研究大多数为单一血液指标或人体测量指标，且主要为横断面研究，无法确定因果关系。为此，本研究采用纵向队列研究，探讨TyG-BRI与脑卒中风险的关系，旨在为识别高风险人群，及早期干预提供依据，从而改善预后、降低脑卒中相关疾病负担。
1　资料与方法
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1.1　资料来源
本研究基于2011—2020年中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）数据。CHARLS于2011年启动全国基线调查，采用多阶段抽样方法，覆盖全国28个省级行政单位、150个县级单位以及450个村级单位。该数据库全面收集了我国45岁及以上中老年人群的人口学特征、健康状况、功能能力、社会经济状况及退休等多维信息，是一套具有全国代表性的高质量微观数据。
CHARLS研究已通过北京大学生物医学伦理委员会的审查批准（伦理批号：IRB00001052-11015），所有参与者在入选研究前均签署了书面知情同意书。本研究下载并使用了共五轮CHARLS数据（2011年、2013年、2015年、2018年及2020年），数据来源网址为：https://charls.pku.edu.cn。
1.2　纳入及排除标准
本研究基于2011年参与CHARLS的基线人群（17 705）。排除标准：年龄小于45岁（162人）；既往有脑卒中病史（包括2011年确诊者，共559人）；有高血压、糖尿病等慢性病（367人）；有慢性肿瘤、慢性肺部疾病（2 528人）；基线体测指标缺失（3 990人）；未完成整个调查周期（2 390人）。最终7 709人纳入队列研究，后续随访中，确诊脑卒中536人，无脑卒中者7 173人。
1.3　观察指标及疾病诊断
1.3.1　指标的计算
TyG计算公式[8]：TyG=In[空腹甘油三酯×空腹血糖/2]，其中空腹血糖单位是mg/dl，甘油三酯的单位是mg/dl。
BRI计算公式[7]：，其中腰围和身高的单位均是m。
TyG-BRI计算公式：TyG-BRI=TyG×BRI
1.3.2　疾病的诊断标准
脑卒中诊断方法：通过问卷标准化问题获得由医生曾经告诉过患者诊断过中风或患者自己提供确诊中风事件的年龄及时间。
1.4　数据的收集
根据临床研究，纳入协变量包括人口统计学（年龄、性别、教育程度、BRI、BMI）、慢性病（高血压、糖尿病）、生活方式（吸烟和饮酒状况）、舒张压、收缩压、实验室检查包括白细胞、平均红细胞体积（mean corpuscular volume，MCV）、血小板、C反应蛋白（c-reactive protein，CRP）、血尿素氮、血红蛋白、葡萄糖、血清肌酐、高密度脂蛋白胆固醇（high density lipoprotein cholesterol，HDL）、低密度脂蛋白胆固醇（low density lipoprotein cholesterol，LDL）、总胆固醇、甘油三酯、糖化血红蛋白A1c（glycated hemoglobin，HbA1c）、尿酸和TyG。
1.5　统计学方法
在统计分析中，对于存在缺失值的数据采用多重插补（MICE，5次迭代），其中连续变量采用预测均值匹配法、二分类变量采用逻辑回归模型插补。组间变量如符合正态分布，以（）表示，比较采用t检验或单因素方差分析；如组间连续变量偏态分布，则以中位数[M（P25，P75）]表示，比较采用U检验，多组间比较采用H检验。计数资料以频数和构成比描述，组间性别、教育水平、吸烟、饮酒、高血压、糖尿病、脑卒中人数比较采用χ2检验。以TyG-BRI的四分位数及连续变量构建模型，逐步纳入不同协变量，建立多个Cox比例风险回归模型，遵守Rubin法则（Rubin Rules）。应用Kaplan-Meier曲线和限制性立方样条（restricted cubic splines，RCS）回归分析TyG-BRI及其与脑卒中风险的关联，通过绘制时间依赖性受试者工作特征（receiver operating characteristic，ROC）曲线，评估TyG-BRI对脑卒中风险的预测效能。将TyG-BRI作为连续变量进行亚组分析及交互作用检验，探讨不同人群中是否存在异质性。此外，采用预后评分匹配，按照1∶4最邻近方法，卡钳值0.2）进行敏感性分析。所有统计分析均使用R软件（版本4.4.3）、SPSS（版本28.0）和GraphPad Prism（版本10.0）完成，检验水准α=0.05。
2　结果
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2.1　TyG-BRI四分位数不同人群基线资料比较
本研究将研究对象按TyG-BRI四分位数划分为四组：Q1组（1 928例）、Q2组（1 927例）、Q3组（1 927例）和Q4组（1 927例）。共纳入7 709例参与者，其中男性3 662例，女性4 047例，平均年龄为59.16岁。随TyG-BRI水平升高，年龄逐渐增大，差异具有统计学意义（P<0.001）。分析显示，白细胞计数、血小板计数、血糖、LDL、总胆固醇、甘油三酯、HbA1c、尿酸、BMI均与TyG-BRI水平呈正相关（P<0.001）；脑卒中、糖尿病和高血压的患病率也随TyG-BRI升高而增加（P<0.001）。而尿素氮、MCV、肌酐和HDL则随TyG-BRI四分位数增加而降低（P<0.001）。此外，Q4组的吸烟和饮酒比例显著低于其他三组，差异均具有统计学意义（P<0.001）。见表1。
2.2　共线性诊断及变量的筛选
基于单因素分析结果，本研究首先进行了多重共线性诊断。方差膨胀因子（variance inflation factor，VIF）分析显示TyG-BRI、BRI、BMI、总胆固醇、TyG指数和LDL-C之间存在高度共线性（VIF>10）。为避免多重共线性干扰，同时结合变量的临床重要性，最终确定纳入年龄、TyG-BRI、收缩压、白细胞计数、MCV、血小板计数、血糖、肌酐、甘油三酯、HDL、LDL、HbA1c和尿酸进行多因素Cox回归分析。BMI的VIF虽小于5，但可能出现对肥胖因素的重复调整，故未将其纳入多因素回归。
2.3　不同水平TyG-BRI与脑卒中之间的Kaplan-Meier曲线和Cox回归
随访期间共新发脑卒中536例，总随访时间为9年，中位随访时长5年，其中TyG-BRI四分位分组（Q1~Q4组）的发病人数分别为80（4.1%）、116（6.0%）、154（8.0%）和186例（9.7%）。Kaplan-Meier生存曲线进一步显示，随着TyG-BRI水平升高，脑卒中累积发病风险呈逐步上升趋势，且组间差异具有统计学意义（P<0.05），见图1。多因素Cox比例风险回归分析结果与上述结论一致，TyG-BRI是脑卒中风险的独立危险因素，见表2。当TyG-BRI作为连续变量，每增加1个标准差，脑卒中风险增加15%（HR=1.15，95%CI：1.03~1.27）。将TyG-BRI按四分位数划分，与Q1组相比，Q4组在模型3中发生脑卒中的风险增加75%（HR=1.75，95%CI：1.28~2.40）。为进一步评估TyG-BRI对脑卒中发生风险的预测效能，绘制时间依赖性ROC曲线，结果显示TyG-BRI预测随访第3、5、7和9年的脑卒中发生率AUC分别为0.621、0.653、0.679、0.761，均高于TyG、BRI单独预测。见图2。
2.4　TyG-BRI与脑卒中之间的非线性效应分析
基于赤池信息准则最小原则及避免模型的过度拟合，选择3个节点构建RCS曲线，探究TyG - BRI与脑卒中风险是否存在非线性关系。结果显示，二者之间非线性关系统计学意义不显著（P for nonlinear=0.053），总体趋势表明，TyG-BRI水平与脑卒中风险之间呈正相关（P for overall<0.05）。见图3。
2.5　TyG-BRI与脑卒中之间的亚组分析
在不同BMI、糖尿病、高血压、吸烟及饮酒等亚组分析分层中，连续变量TyG-BRI与脑卒中风险的交互作用均无统计学意义（P for interaction>0.05）。性别亚组中交互作用存在统计学意义（P for interaction<0.05），但经Bonferroni多重检验校正后，交互作用的统计学意义也不显著（校正P for interaction=0.19）。见图4。
2.6　敏感性分析
本研究采用预后评分匹配进行敏感性分析。基于基线对照人群协变量构建脑卒中风险预测模型，以预后评分进行1:4匹配（卡钳值0.2）。匹配后脑卒中组529人、非脑卒中组2 085人，两组基线特征达到平衡（SMD<0.1）。同时匹配后Cox分析显示，与TyG-BRI Q1组相比，Q4组卒中风险显著升高（HR=1.76，95% CI：1.18~2.61，P=0.005）。
3　讨论
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本研究基于CHARLS数据库2011—2020年的纵向数据，探讨了TyG-BRI指数与中国中老年人群脑卒中发生风险之间的关系。结果表明，TyG-BRI水平与脑卒中风险呈显著正相关。在调整多种变量、亚组分层及进行敏感性分析后，该关联依然有统计学意义。
TyG指数作为高效、便捷的IR的代替指标，已在多项研究显示，其与动脉粥样硬化以及多种心血管疾病，如高血压、中风和冠心病，均存在独立关联[9-10]。同时升高的TyG指数被证实与脑卒中多项不良长期临床结局密切相关，包括长期生存率降低[11]、全因死亡率[12]以及1年后卒中复发风险[13]。IR可以通过全身炎症反应，减弱胰岛素敏感性，加速泡沫细胞形成，从而导致动脉粥样硬化及斑块的形成[14]。部分研究发现IR可能会通过氧化途径，导致促炎粘附分子、或胰岛素样生长因子过度表达，对血小板的粘附、聚集等产生影响[15]。此外，IR通过抑制PI3 - K途径、或激活内皮钠通道，从而促进动脉收缩及僵硬[16]。上述机制可能参与了脑卒中的发生发展。
TyG指数联合BMI[17]、腰围[18]往往比两者单独使用对代谢性疾病有更高的预测价值。但也有少数研究发现单独TyG（AUC：0.545）预测效能优于联合指标TyG-腰围、TyG-BMI（AUC值分别为0.536、0.528）[19]。出现上述结果差异的原因可能在于，在BMI和腰围正常的人群中，部分个体仍可能存在内脏脂肪堆积或异位脂肪分布。这类BMI界定为非肥胖的个体，可能因内脏脂肪异常积聚或脂肪异位沉积导致代谢风险存在异质性，从而减弱TyG指数对代谢疾病或心脑血管疾病的预测能力。BRI是当前一种新型人体测量指标，在预测体脂率和内脏脂肪组织百分比方面，相较于BMI和腰围有明显的优势。本研究发现，TyG-BRI在随访的时间段内，预测效能均更高，如随访9年AUC达0.761，而同期单独使用TyG和BRI的AUC为0.703、0.657。近期研究表明，BRI与多种慢性疾病的发生均密切相关，包括糖尿病、心血管疾病和结肠肿瘤等[20-22]。内脏脂肪堆积导致活性氧增加，促炎细胞因子水平增高，脂肪因子分泌失调等因素，增加脑卒中的风险[23]。本研究采用TyG-BRI四分位数进行Cox回归分析，结果显示，在调整不同混杂变量后其效应值有所衰减，但TyG-BRI仍是脑卒中发生风险的独立危险因素（P<0.05）。值得注意的是模型3中Q4与Q3效应相对持平，可能与此次纳入的部分变量相关，如调整LDL可能导致削弱脂蛋白异常对脑卒中的影响。RCS分析结果表明，TyG-BRI与脑卒中风险之间非线性关系不显著，两者之间整体趋势呈正相关。Wang等[24]的研究结果同样指出，TyG-BRI和心脑血管风险存在线性关联，这一发现与本研究结果相仿；然而，该研究并未进一步探讨TyG-BRI的具体风险临界值，而本研究则明确了这一关键数值，为临床风险评估提供了更精确的参考依据。
本研究优势在于，数据样本的人群具备良好的人群代表性，使得研究结论在我国中老年群体中具有较强的适用性与参考价值。其次，研究基于纵向数据分析，比横断面研究能更清晰地解释二者间因果关系。但也存在一定局限性，主要包括以下几个方面：其一，结局指标无法进一步区分脑卒中的具体亚型（如缺血性脑卒中、出血性脑卒中），难以分析TyG-BRI与不同亚型脑卒中风险的关联差异。其二，本研究数据来源于回顾性资料，回忆偏倚、测量偏倚难以完全避免，可能对结果准确性有影响。其三，研究通过多重插补法对缺失数据进行处理，并在回归模型中尽可能纳入目前已知混杂因素，但仍可能存在遗漏其他相关混杂因素。
综上所述，新型TyG-BRI与我国中老年人脑卒中风险独立相关，尤其是BMI正常但存在内脏性肥胖的患者中，能更早期的识别高危人群。

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2026年第53卷第7期
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doi: 10.20043/j.cnki.MPM.202510302
  • 接收时间：2025-10-22
  • 首发时间：2026-11-02
  • 出版时间：2026-04-10
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    湖州市妇幼保健院内科，浙江　湖州　313000

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