新型胰岛素抵抗相关指标在心血管–肾脏–代谢综合征应用的研究进展
Research Progress and the Clinical Utility of Novel Insulin Resistance-Related Indices in Cardiovascular-Kidney-Metabolic Syndrome
DOI: 10.12677/acm.2026.1693175, PDF,   
作者: 高可昕：浙江大学医学院，浙江 杭州；杨 毅*：浙江大学医学院附属第二医院肾病科，浙江 杭州
关键词: 心血管–肾脏–代谢综合征；胰岛素抵抗；肥胖；心血管疾病；Cardiovascular-Kidney-Metabolic Syndrome； Insulin Resistance； Obesity； Cardiovascular Disease
摘要: 2023年，美国心脏协会提出了心血管–肾脏–代谢综合征的概念，强调要将代谢因素、肾脏疾病和心血管疾病作为一个整体进行评估和管理。其中，肥胖和胰岛素抵抗作为关键的代谢因素，在心血管–肾脏–代谢综合征的发生发展中起着始动作用。鉴于传统测量胰岛素抵抗的指标和工具的局限性，新型胰岛素抵抗的替代指标正不断被研发并在临床中得到验证。本文旨在综合分析新型胰岛素抵抗相关指标的构建及其在心血管–肾脏–代谢综合征群体中的临床应用价值，以期为实现心血管–肾脏–代谢综合征患者早期识别及预后分析提供参考。
Abstract: In 2023, the American Heart Association introduced the concept of cardiovascular-kidney-metabolic (CKM) syndrome, emphasizing the need to evaluate and manage metabolic factors, kidney disease, and cardiovascular disease as an integrated entity. Among these, obesity and insulin resistance serve as pivotal metabolic drivers that initiate and perpetuate the pathogenesis and progression of CKM syndrome. Given the inherent limitations of conventional indices and tools for assessing insulin resistance, novel surrogate indices are being continually developed and clinically validated. This review aims to provide a comprehensive analysis of the construction of emerging insulin resistance-related indicators and their clinical utility in the CKM syndrome population, with the goal of informing early identification and prognostic stratification in patients with CKM syndrome.
文章引用：高可昕, 杨毅. 新型胰岛素抵抗相关指标在心血管–肾脏–代谢综合征应用的研究进展[J]. 临床医学进展, 2026, 16(9): 1373-1381. https://doi.org/10.12677/acm.2026.1693175

参考文献

[1] Ndumele, C.E., Rangaswami, J., Chow, S.L., Neeland, I.J., Tuttle, K.R., Khan, S.S., et al. (2023) Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory from the American Heart Association. Circulation, 148, 1606-1635.
https://doi.org/10.1161/cir.0000000000001184
[2] He, D., Zhang, X., Li, C., Yang, C., Yu, M., Wang, J., et al. (2025) Rising Prevalence of Cardiovascular-Kidney-Metabolic Syndrome in China, 2010-2019. Journal of the American College of Cardiology, 86, 213-216.
https://doi.org/10.1016/j.jacc.2025.05.030
[3] Ndumele, C.E., Neeland, I.J., Tuttle, K.R., Chow, S.L., Mathew, R.O., Khan, S.S., et al. (2023) A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Scientific Statement from the American Heart Association. Circulation, 148, 1636-1664.
https://doi.org/10.1161/cir.0000000000001186
[4] Tabák, A.G., Herder, C., Rathmann, W., Brunner, E.J. and Kivimäki, M. (2012) Prediabetes: A High-Risk State for Diabetes Development. The Lancet, 379, 2279-2290.
https://doi.org/10.1016/s0140-6736(12)60283-9
[5] Artunc, F., Schleicher, E., Weigert, C., Fritsche, A., Stefan, N. and Häring, H. (2016) The Impact of Insulin Resistance on the Kidney and Vasculature. Nature Reviews Nephrology, 12, 721-737.
https://doi.org/10.1038/nrneph.2016.145
[6] DeFronzo, R.A., Tobin, J.D. and Andres, R. (1979) Glucose Clamp Technique: A Method for Quantifying Insulin Secretion and Resistance. American Journal of Physiology-Endocrinology and Metabolism, 237, E214.
https://doi.org/10.1152/ajpendo.1979.237.3.e214
[7] Tahapary, D.L., Pratisthita, L.B., Fitri, N.A., Marcella, C., Wafa, S., Kurniawan, F., et al. (2022) Challenges in the Diagnosis of Insulin Resistance: Focusing on the Role of HOMA-IR and Tryglyceride/Glucose Index. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 16, Article ID: 102581.
https://doi.org/10.1016/j.dsx.2022.102581
[8] Tao, L., Xu, J., Wang, T., Hua, F. and Li, J. (2022) Triglyceride-Glucose Index as a Marker in Cardiovascular Diseases: Landscape and Limitations. Cardiovascular Diabetology, 21, Article No. 68.
https://doi.org/10.1186/s12933-022-01511-x
[9] Sharafi, M., Amiri, Z., Pezeshki, B., Mohsenpour, M.A., Eftekhari, M.H., Afrashteh, S., et al. (2023) Predictive Value of Triglycerides to High-Density Lipoprotein Cholesterol and Triglyceride Glycemic Index for Diabetes Incidence in Pre-Diabetes Patients: A Prospective Cohort Study. Journal of Health, Population and Nutrition, 42, Article No. 67.
https://doi.org/10.1186/s41043-023-00410-5
[10] Yu, C., Shi, Y., Wang, T., Zhu, L., Zhou, W., Bao, H., et al. (2024) Triglyceride-Glucose Index Change and Chronic Kidney Disease Progression in a Chinese Hypertensive Population. Frontiers in Endocrinology, 15, Article ID: 1342408.
https://doi.org/10.3389/fendo.2024.1342408
[11] Jiao, Y., Su, Y., Shen, J., Hou, X., Li, Y., Wang, J., et al. (2022) Evaluation of the Long-Term Prognostic Ability of Triglyceride-Glucose Index for Elderly Acute Coronary Syndrome Patients: A Cohort Study. Cardiovascular Diabetology, 21, Article No. 3.
https://doi.org/10.1186/s12933-021-01443-y
[12] Ruan, G.-T., Xie, H.-L., Zhang, H.-Y., et al. (2022) A Novel Inflammation and Insulin Resistance Related Indicator to Predict the Survival of Patients with Cancer. Frontiers in Endocrinology, 13, Article ID: 905266.
https://doi.org/10.3389/fendo.2022.905266
[13] Ma, X., Ma, X., Wang, Y., Qiu, G. and Zhang, C. (2025) Associations of Cumulative Exposure and Dynamic Trajectories of the C-Reactive Protein-Triglyceride-Glucose Index with Incident Cardiovascular Disease in Middle-Aged and Older Chinese Adults: A Nationwide Cohort Study. Cardiovascular Diabetology, 24, Article No. 303.
https://doi.org/10.1186/s12933-025-02869-4
[14] Dobiás̆ová, M. and Frohlich, J. (2001) The Plasma Parameter Log (TG/HDL-C) as an Atherogenic Index: Correlation with Lipoprotein Particle Size and Esterification Rate Inapob-Lipoprotein-Depleted Plasma (FERHDL). Clinical Biochemistry, 34, 583-588.
https://doi.org/10.1016/s0009-9120(01)00263-6
[15] Williams, K.V., Erbey, J.R., Becker, D., Arslanian, S. and Orchard, T.J. (2000) Can Clinical Factors Estimate Insulin Resistance in Type 1 Diabetes? Diabetes, 49, 626-632.
https://doi.org/10.2337/diabetes.49.4.626
[16] Tan, M.-Y., Jiang, Z.-N., Li, Y.-Q., Li, Z.-Y. and Niu, B. (2025) Association of Estimated Glucose Disposition Rate with Aging Acceleration and Mortality Risk in Individuals with Cardiovascular-Kidney-Metabolic Syndrome: Evidence from Two Large National Population-Based Studies. Cardiovascular Diabetology, 24, Article No. 402.
https://doi.org/10.1186/s12933-025-02940-0
[17] Ikee, R., Hamasaki, Y., Oka, M., Maesato, K., Mano, T., Moriya, H., et al. (2008) Glucose Metabolism, Insulin Resistance, and Renal Pathology in Non-Diabetic Chronic Kidney Disease. Nephron Clinical Practice, 108, c163-c168.
https://doi.org/10.1159/000115329
[18] De Cosmo, S., Menzaghi, C., Prudente, S. and Trischitta, V. (2013) Role of Insulin Resistance in Kidney Dysfunction: Insights into the Mechanism and Epidemiological Evidence. Nephrology Dialysis Transplantation, 28, 29-36.
https://doi.org/10.1093/ndt/gfs290
[19] Hill, M.A., Yang, Y., Zhang, L., Sun, Z., Jia, G., Parrish, A.R., et al. (2021) Insulin Resistance, Cardiovascular Stiffening and Cardiovascular Disease. Metabolism, 119, Article ID: 154766.
https://doi.org/10.1016/j.metabol.2021.154766
[20] Liu, S., Sun, H., Liu, J. and Wang, G. (2024) Accessing the Relationship between Six Surrogate Insulin Resistance Indexes and the Incidence of Rapid Kidney Function Decline and the Progression to Chronic Kidney Disease among Middle-Aged and Older Adults in China: Results from the China Health and Retirement Longitudinal Study. Diabetes Research and Clinical Practice, 212, Article ID: 111705.
https://doi.org/10.1016/j.diabres.2024.111705
[21] Chen, X., Wang, Y., Dong, M., Ma, Y., Bo, Y., Wang, Y., et al. (2025) Triglyceride Glucose Index and Atherogenic Index of Plasma Predict Rapid Kidney Function Decline in Cardiovascular-Kidney-Metabolic Syndrome: The First Longitudinal Evidence from CHARLS. European Journal of Medical Research, 31, Article No. 174.
https://doi.org/10.1186/s40001-025-03751-5
[22] Hong, J., Zhang, R., Tang, H., Wu, S., Chen, Y. and Tan, X. (2025) Comparison of Triglyceride Glucose Index and Modified Triglyceride Glucose Indices in Predicting Cardiovascular Diseases Incidence among Populations with Cardiovascular-Kidney-Metabolic Syndrome Stages 0-3: A Nationwide Prospective Cohort Study. Cardiovascular Diabetology, 24, Article No. 98.
https://doi.org/10.1186/s12933-025-02662-3
[23] Wu, L. and Huang, Z. (2024) Elevated Triglyceride Glucose Index Is Associated with Advanced Cardiovascular Kidney Metabolic Syndrome. Scientific Reports, 14, Article No. 31352.
https://doi.org/10.1038/s41598-024-82881-y
[24] Zhang, P., Mo, D., Zeng, W. and Dai, H. (2025) Association between Triglyceride-Glucose Related Indices and All-Cause and Cardiovascular Mortality among the Population with Cardiovascular-Kidney-Metabolic Syndrome Stage 0-3: A Cohort Study. Cardiovascular Diabetology, 24, Article No. 92.
https://doi.org/10.1186/s12933-025-02642-7
[25] Jin, X., Feng, Y., Liu, C., Cheng, T., Jin, Y., Shao, Z., et al. (2026) Association between Triglyceride-Glucose Index and Related Indicators with Heart Failure-Related Mortality in Individuals with Early-Stage Cardiovascular-Kidney-Metabolic Syndrome. Cardiovascular Diabetology, 25, Article No. 145.
https://doi.org/10.1186/s12933-026-03149-5
[26] Jin, T., Tang, X., Han, Y., Fan, H., Qin, Q., Jiang, H., et al. (2026) Relationship between Nine Triglyceride-Glucose-Related Indices and Cardiometabolic Multimorbidity Incidence in Patients with Cardiovascular-Kidney-Metabolic Syndrome Stage 0-3: A Nationwide Prospective Cohort Study. Cardiovascular Diabetology, 25, Article No. 36.
https://doi.org/10.1186/s12933-026-03077-4
[27] Dong, B., Chen, Y., Yang, X., Chen, Z., Zhang, H., Gao, Y., et al. (2025) Estimated Glucose Disposal Rate Outperforms Other Insulin Resistance Surrogates in Predicting Incident Cardiovascular Diseases in Cardiovascular-Kidney-Metabolic Syndrome Stages 0-3 and the Development of a Machine Learning Prediction Model: A Nationwide Prospective Cohort Study. Cardiovascular Diabetology, 24, Article No. 163.
https://doi.org/10.1186/s12933-025-02729-1
[28] Fu, C., Zhang, Z., Li, Y., Wang, F., Li, C., Xie, Z., et al. (2026) Association of the Estimated Glucose Disposal Rate Combined with a Body Shape Index with All-Cause and Cardiovascular-Specific Mortality among Individuals with Cardiovascular-Kidney-Metabolic Syndrome. Cardiovascular Diabetology, 25, Article No. 112.
https://doi.org/10.1186/s12933-026-03127-x
[29] Ou, H., Wei, M., Li, X. and Xia, X. (2025) C-Reactive Protein-Triglyceride Glucose Index in Evaluating Cardiovascular Disease and All-Cause Mortality Incidence among Individuals across Stages 0-3 of Cardiovascular-Kidney-Metabolic Syndrome: A Nationwide Prospective Cohort Study. Cardiovascular Diabetology, 24, Article No. 296.
https://doi.org/10.1186/s12933-025-02848-9
[30] Niu, Z.-J., Liu, Z.-A., Wei, T., Dou, M., Tian, P. and Cui, Y. (2026) Association between the Combined C-Reactive Protein-Triglyceride Glucose Index and Hypertension with Long-Term Stroke among Cardiovascular-Kidney-Metabolic Syndrome Stages 0-3 Population: A Nationwide Prospective Cohort Study. Cardiovascular Diabetology, 25, Article No. 55.
https://doi.org/10.1186/s12933-026-03075-6
[31] Ying, Q., He, F., Wu, L., Wei, Q. and Xu, J. (2025) C-Reactive Protein-Triglyceride Glucose Index Predicts Mortality in Cardiovascular-Kidney-Metabolic Syndrome Stage 0-3: A Prospective Cohort Study. Diabetology & Metabolic Syndrome, 17, Article No. 382.
https://doi.org/10.1186/s13098-025-01947-7
[32] Yuan, L., Zhao, Z., Peng, H., Zong, W., Zhu, J., Qu, H., et al. (2026) Associations between the C-Reactive Protein-Triglyceride Glucose Index and the Incidence and Progression Trajectory of Cardiometabolic Multimorbidity: A Multi-State Model Study. Cardiovascular Diabetology, 25, Article No. 125.
https://doi.org/10.1186/s12933-026-03174-4
[33] Wang, X., Wen, P., Liao, Y., Wu, T., Zeng, L., Huang, Y., et al. (2025) Association of Atherogenic Index of Plasma and Its Modified Indices with Stroke Risk in Individuals with Cardiovascular-Kidney-Metabolic Syndrome Stages 0-3: A Longitudinal Analysis Based on CHARLS. Cardiovascular Diabetology, 24, Article No. 254.
https://doi.org/10.1186/s12933-025-02784-8
[34] Liu, Y., Li, W., Zhou, H., Zeng, H., Jiang, J., Wang, Q., et al. (2025) Association between Atherogenic Index of Plasma and New-Onset Stroke in a Population with Cardiovascular-Kidney-Metabolic Syndrome Stages 0-3: Insights from CHARLS. Cardiovascular Diabetology, 24, Article No. 168.
https://doi.org/10.1186/s12933-025-02732-6
[35] Chen, M., Guo, J., Shangguan, Y., Sun, Z., He, X., Tu, Q., et al. (2025) Association of the Triglyceride-Glucose Index Combined with a Body Shape Index with All-Cause and Cardiovascular Mortality in Individuals with Cardiovascular-Kidney-Metabolic Syndrome Stage 0-3: Findings from Two Prospective Cohorts. Cardiovascular Diabetology, 24, Article No. 366.
https://doi.org/10.1186/s12933-025-02921-3
[36] Lu, L., Chen, Y., Liu, B., Li, X., Wang, J., Nie, Z., et al. (2025) Association between Cumulative Changes of the Triglyceride Glucose Index and Incidence of Stroke in a Population with Cardiovascular-Kidney-Metabolic Syndrome Stage 0-3: A Nationwide Prospective Cohort Study. Cardiovascular Diabetology, 24, Article No. 202.
https://doi.org/10.1186/s12933-025-02754-0
[37] Zhang, C., Chen, Y., Wang, T., Peng, W., Ning, M. and Liu, Y. (2025) Inflammation and Abnormal Glucose-Lipid Metabolism Are Critical for Population Stratification toward Progressive Frailty in Cardiovascular-Kidney-Metabolic Syndrome. Diabetes Research and Clinical Practice, 230, Article ID: 112989.
https://doi.org/10.1016/j.diabres.2025.112989
[38] Chen, J., Yan, L., He, L. and Wang, W. (2025) Association between Different Dimensions of the C-Reactive Protein-Triglyceride-Glucose Index and Future Cardiovascular Disease Risk in Individuals with Cardiovascular-Kidney-Metabolic Syndrome Stages 0-3: A Nationwide Cohort Study. Diabetology & Metabolic Syndrome, 17, Article No. 299.
https://doi.org/10.1186/s13098-025-01882-7
[39] Zhang, Y., Song, Y., Lu, Y., Liu, T. and Yin, P. (2025) Atherogenic Index of Plasma and Cardiovascular Disease Risk in Cardiovascular-Kidney-Metabolic Syndrome Stage 1 to 3: A Longitudinal Study. Frontiers in Endocrinology, 16, Article ID: 1517658.
https://doi.org/10.3389/fendo.2025.1517658
[40] Shang, Z., Feng, S., Qian, H., Deng, Z., Wang, Y. and Gao, Y. (2025) The Impact of the Triglyceride-Glucose Index on the Deterioration of Kidney Function in Patients with Cardiovascular-Kidney-Metabolic Syndrome: Insight from a Large Cohort Study in China. Renal Failure, 47, Article ID: 2446656.
https://doi.org/10.1080/0886022x.2024.2446656
[41] Han, Y., Zhang, K., Luo, Y., Wan, B., Zhang, Y., Huang, Q., et al. (2024) Relationship between Stroke and Estimated Glucose Disposal Rate: Results from Two Prospective Cohort Studies. Lipids in Health and Disease, 23, Article No. 392.
https://doi.org/10.1186/s12944-024-02385-6

为你推荐