TyG-VAI与代谢功能障碍相关脂肪性肝病患病风险关系的研究进展

Research Progress on the Association of TyG-VAI with the Risk of Metabolic Dysfunction-Associated Steatotic Liver Disease

摘要: 代谢功能障碍相关脂肪性肝病(metabolic dysfunction-associated steatotic liver disease, MASLD)是目前最常见的慢性肝病之一，其患病率持续上升，并与2型糖尿病、心血管疾病、慢性肾脏病及肝细胞癌等多种不良结局密切相关。由于MASLD的发生发展与胰岛素抵抗、糖脂代谢紊乱、内脏脂肪堆积及脂肪组织功能异常密切相关，寻找简便、经济、稳定的无创指标，对疾病的早期识别和风险分层具有重要意义。甘油三酯–葡萄糖指数(triglyceride-glucose index, TyG)是反映胰岛素抵抗的常用替代指标，内脏脂肪指数(visceral adiposity index, VAI)主要用于反映内脏脂肪分布及脂肪组织功能异常。二者分别从糖脂代谢异常和内脏脂肪功能失衡两个方面反映MASLD的核心代谢特征。近年来，越来越多研究表明，TyG、VAI及其相关衍生指标与脂肪肝或MASLD风险密切相关，但单一指标对疾病复杂代谢背景的反映仍然有限。甘油三酯–葡萄糖–内脏脂肪指数(triglyceride glucose-visceral adiposity index, TyG-VAI)作为进一步整合胰岛素抵抗和内脏脂肪异常信息的复合指标，理论上可能更全面地反映MASLD的代谢特征，并在风险识别中具有潜在优势。本文对MASLD的代谢基础、TyG与VAI在脂肪肝风险评估中的研究进展，以及TyG-VAI用于MASLD风险评估的理论依据和潜在价值进行了综述，以期为后续相关研究和临床无创筛查提供参考。

Abstract: Metabolic dysfunction-associated steatotic liver disease (MASLD) is one of the most common chronic liver diseases worldwide. Its prevalence continues to rise, and it is closely associated with multiple adverse outcomes, including type 2 diabetes, cardiovascular disease, chronic kidney disease, and hepatocellular carcinoma. Because the development of MASLD is closely linked to insulin resistance, disordered glucose and lipid metabolism, visceral fat accumulation, and adipose tissue dysfunction, the identification of simple, affordable, and reliable non-invasive indicators is of great importance for early detection and risk stratification. The triglyceride-glucose (TyG) index is widely used as a surrogate marker of insulin resistance, whereas the visceral adiposity index (VAI) is mainly used to reflect visceral fat distribution and adipose tissue dysfunction. These two indices capture key metabolic features of MASLD from the perspectives of glucose-lipid metabolic disturbance and visceral adipose dysfunction, respectively. In recent years, growing evidence has shown that TyG, VAI, and their related derivatives are closely associated with the risk of fatty liver disease or MASLD; however, single indicators may not fully reflect the complex metabolic background of the disease. As a composite index that further integrates information on insulin resistance and visceral adiposity abnormality, triglyceride glucose-visceral adiposity index (TyG-VAI) may provide a more comprehensive assessment of the metabolic characteristics of MASLD and may offer potential advantages in risk identification. This review summarizes the metabolic basis of MASLD, the research progress on TyG and VAI in fatty liver risk assessment, and the theoretical rationale and potential value of TyG-VAI in MASLD risk evaluation, with the aim of providing a reference for future studies and non-invasive clinical screening.