胰岛素抵抗及其新型替代指标在心血管疾病中的作用：叙述性文献综述

The Role of Insulin Resistance and Its Novel Surrogate Indexes in Cardiovascular Disease: A Narrative Literature Review

摘要: 心血管疾病(CVD)是全球主要的致死原因之一，胰岛素抵抗(IR)作为其独立风险因素，即使在非糖尿病人群中亦然，通过中断胰岛素信号通路(如PI3K/Akt途径)、促进内皮功能障碍、氧化应激、炎症和血栓形成等机制，加速动脉粥样硬化和CVD进展。传统IR评估方法如高胰岛素正常血糖钳夹试验(HEC)和稳态模型评估胰岛素抵抗指数(HOMA-IR)操作复杂且成本高昂，限制其临床和流行病学应用。本综述通过PubMed数据库检索关键词“insulin resistance”“cardiovascular disease”“triglyceride-glucose index”和“METS-IR”，纳入叙述性综述、荟萃分析、队列研究和回顾性研究，旨在回顾IR在CVD中的病理生理作用，评估新型非胰岛素依赖替代指标如甘油三酯–葡萄糖指数(TyG指数)和胰岛素抵抗代谢评分(METS-IR)的进展，并识别现有知识缺口。结果显示，TyG指数与高血压、动脉硬化、动脉粥样硬化性心血管疾病(ASCVD)风险、冠心病(CAD)严重程度和预后(如主要不良心血管事件，MACE)显著相关，并可提升GRACE评分的预测价值(如AUC增加)；METS-IR在某些研究中优于TyG指数预测CAD严重程度，但两者比较结果不一致，一些研究支持TyG在预后评估中的优势。现有证据主要基于观察性研究，异质性高、人群偏倚明显(多局限于亚洲人群)。未来需开展多民族纵向队列研究、头对头比较以及随机对照试验，验证这些指标的临床转化价值，以指导CVD风险分层和个性化干预。

Abstract: Cardiovascular disease (CVD) is one of the leading causes of death worldwide. Insulin resistance (IR), as an independent risk factor for CVD—even in non-diabetic populations—accelerates atherosclerosis and CVD progression by disrupting insulin signaling pathways (such as the PI3K/Akt pathway) and promoting endothelial dysfunction, oxidative stress, inflammation, and thrombosis. Traditional IR assessment methods, such as the hyperinsulinemic-euglycemic clamp (HEC) and the homeostasis model assessment of insulin resistance (HOMA-IR), are operationally complex and costly, limiting their clinical and epidemiological applications. This review searched the PubMed database using keywords “insulin resistance”, “cardiovascular disease”, “triglyceride-glucose index”, and “METS-IR”, and included narrative reviews, meta-analyses, cohort studies, and retrospective studies. It aims to review the pathophysiological role of IR in CVD, evaluate the progress of novel non-insulin-dependent surrogate markers such as the triglyceride-glucose index (TyG index) and the metabolic score for insulin resistance (METS-IR), and identify existing knowledge gaps. Results show that the TyG index is significantly associated with hypertension, arterial stiffness, atherosclerotic cardiovascular disease (ASCVD) risk, coronary artery disease (CAD) severity, and prognosis (such as major adverse cardiovascular events, MACE), and can enhance the predictive value of the GRACE score (e.g., increased AUC). METS-IR outperforms the TyG index in predicting CAD severity in some studies, but comparison results between the two are inconsistent, with some studies supporting the superiority of TyG in prognostic assessment. Existing evidence is primarily based on observational studies, with high heterogeneity and evident population bias (mostly limited to Asian populations). In the future, multi-ethnic longitudinal cohort studies, head-to-head comparisons, and randomized controlled trials are needed to validate the clinical translational value of these indicators, in order to guide CVD risk stratification and personalized interventions.