TyG指数对糖尿病肾病患者进展至终末期肾脏病风险的预测价值

Predictive Value of the Triglyceride-Glucose Index for End-Stage Renal Disease Risk in Patients with Diabetic Kidney Disease

摘要: 目的：探讨甘油三酯–葡萄糖(TyG)指数对糖尿病肾脏病(DKD)患者终末期肾脏病(ESRD)风险的预测价值。方法：采用回顾性病例对照研究设计，选取2015年1月至2025年1月就诊于重庆医科大学附属永川医院内分泌科及肾病风湿科的糖尿病肾病(DKD)患者共206例，根据ESRD(即估计肾小球滤过率小于15 mL/min/1.73m²或开始透析或肾移植)状态，分为ESRD组102例和非ESRD组104例，统计各组病例性别、年龄、糖尿病病程、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、糖化血红蛋白(HbAlc)、肾功能、血脂及尿蛋白，计算TyG指数。采用多变量二元Logistic回归模型估计比值比(OR)和95%置信区间(CI)。研究TyG指数与DKD患者ESRD之间的关系，通过受试者操作特征曲线(ROC)评估计TyG指数及其联合模型(包含eGFR、尿蛋白)对DKD患者ESRD的预测效能。结果：ESRD组的基线TyG指数显著高于非ESRD组(9.57 ± 0.58 vs 9.12 ± 0.69, P < 0.05)。Logistic回归分析显示TyG指数是DKD患者ESRD风险的独立危险因素(未调整模型OR = 2.155，95%CI 1.546~3.005，P < 0.001；完全调整的模型：OR 2.100，95%CI 1.284~3.435, P = 0.003)。ROC曲线分析结果显示，TyG指数单独诊断ESRD的AUC为0.687 (95%CI: 0.616~0.759, P = 0.000)；TyG指数联合eGFR及尿蛋白的联合预测模型AUC为0.814 (95%CI: 0.757~0.872, P = 0.000)，两组比较差异具有统计学意义(Z = 2.58, P = 0.004)。结论：高的TyG指数与DKD患者ESRD风险增加相关，TyG可作为ESRD风险的简易筛查指标，联合常规肾功能指标可提升其预测效能。

Abstract: Objective: To explore the predictive value of triglyceride-glucose (TyG) index for the risk of end-stage renal disease (ESRD) in patients with diabetic kidney disease (DKD). Methods: A retrospective case-control study was conducted. A total of 206 patients with diabetic kidney disease (DKD) admitted to the Department of Endocrinology and the Department of Nephrology and Rheumatology of Yongchuan Hospital Affiliated to Chongqing Medical University from January 2015 to January 2025 were enrolled. According to the status of ESRD (estimated glomerular filtration rate < 15 mL/min/1.73m² or initiation of dialysis or renal transplantation), 102 cases were divided into ESRD group and 104 cases into non-ESRD group. The gender, age, duration of diabetes, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), glycosylated hemoglobin (HbAlc), renal function, blood lipid and urine protein were recorded, and TyG index was calculated. Multivariable binary Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI). The relationship between TyG index and ESRD in DKD patients was studied, and the receiver operating characteristic curve (ROC) was used to evaluate the predictive efficacy of TyG index and its combined model (including eGFR and urinary protein) for ESRD in DKD patients. Results: The baseline TyG index in ESRD group was significantly higher than that in non-ESRD group (9.57 ± 0.58 vs 9.12 ± 0.69, P < 0.05). Logistic regression analysis showed that TyG index was an independent risk factor for ESRD in DKD patients (unadjusted model OR = 2.155, 95%CI 1.546~3.005, P < 0.001; Fully adjusted model: OR 2.100, 95%CI 1.284~3.435, P = 0.003). ROC curve analysis showed that the AUC of TyG index alone in the diagnosis of ESRD was 0.687 (95%CI: 0.616~0.759, P = 0.000). The AUC of TyG index combined with eGFR and urine protein was 0.814 (95%CI: 0.757~0.872, P = 0.000), and the difference between the two groups was statistically significant (Z = 2.58, P = 0.004). Conclusion: High TyG index is associated with an increased risk of ESRD in DKD patients. TyG can be used as a simple screening indicator for the risk of ESRD, and its predictive efficiency can be improved when combined with conventional renal function indicators.