目的 探讨透析患者三酰甘油葡萄糖(triglyceride glucose,TyG)乘积指数与冠状动脉钙化(coronary artery calcification，CAC)的关系，同时分析影响CAC的危险因素。 方法 选取2019年10月～2021年3月在安徽医科大学第二附属医院肾脏内科住院的透析患者。收集患者的一般临床资料及实验室检查结果，用多层螺旋计算机断层扫描(multi-layer spiral computed tomography，MSCT)检查患者CAC的情况。根据是否发生冠状动脉钙化将患者分为无钙化组和钙化组。比较2组之间各指标的差异，运用二元Logistic回归分析及ROC曲线评估TyG指数对透析患者CAC的预测价值。 结果 共纳入286例透析患者(血液透析219例，腹膜透析67例)，钙化组157例，无钙化组129例。与非钙化组相比，钙化组年龄、透析龄、CRP、TyG指数及全段甲状旁腺激素(iPTH)均明显升高(Z值分别为-7.642，-5.226， -5.152，-3.460，-1.989；P值分别为＜0.001，＜0.001，＜0.001，0.001，0.047)。Spearman相关性分析显示CAC与年龄、透析龄、CRP、iPTH及TyG指数呈正相关(r值分别为0.453,0.310,0.305,0.118,0.326； P值分别为＜0.001，＜0.001，＜0.001，0.047，＜0.001)。二元Logistic回归分析结果显示：年龄(OR=1.085,95% CI 1.060～1.111，P＜0.001)、透析龄(OR=1.010,95%CI 1.004～1.017，P＜0.001)、CRP(OR=1.060,95% CI：1.021～1.102，P=0.003)、TyG指数(OR=2.309,95%CI 1.370～3.892，P =0.002)为CAC的危险因素。ROC曲线分析结果显示，TyG指数与年龄联合指标对透析患者CAC的发生预测价值最大，曲线下面积为0.807(95%CI 0.756～0.857,P＜0.001)。 结论 年龄、透析龄、CRP、TyG指数是透析患者CAC的独立危险因素，且TyG指数与年龄的联合指标对透析患者CAC的发生有着较好的预测价值。
Objective To investigate the relationship between triglyceride glucose (TyG) index and coronary artery calcification (CAC) in dialysis patients, and to analyze the risk factors for CAC. Methods The dialysis patients hospitalized in the Nephrology Department, the Second Affiliated Hospital of Anhui Medical University from October 2019 to March 2021 were recruited. Their general clinical data and laboratory results were collected, and CAC of the patients was examined by multi-layer spiral computed tomography (MSCT). They were then divided into CAC group and non-CAC group according to the MSCT findings. These indexes were compared between the two groups. Binary logistic regression analysis and ROC curve were used to assess the predictive value of TyG index for CAC in dialysis patients. Results A total of 286 dialysis patients (219 hemodialysis and 67 peritoneal dialysis) were included in this study, in which 157 were in CAC group and 129 in non-CAC group. Age, dialysis age, CRP, TyG index and intact parathyroid hormone (iPTH) were significantly higher in CAC group than in non-CAC group (Z=-7.642, -5.226, -5.152, -3.460 and -1.989, respectively; P＜0.001, ＜0.001, ＜0.001, =0.001 and =0.047, respectively). Spearman correlation analysis showed a positive correlation between CAC and age, dialysis age, CRP, iPTH and TyG index (r=0.453, 0.310, 0.305, 0.118 and 0.326, respectively; P＜0.001,＜0.001,＜0.001, =0.047 and ＜0.001, respectively). Binary logistic regression analysis found that age (OR=1.085, 95% CI: 1.060~1.111, P< 0.001), dialysis age (OR=1.010, 95% CI: 1.004~1.017, P<0.001), CRP (OR=1.060, 95% CI: 1.021~1.102, P=0.003), and TyG index (OR=2.309, 95% CI: 1.370~3.892, P=0.002) were the risk factors for CAC. ROC curve analysis showed that TyG index associated with age had the greatest predictive value for the occurrence of CAC in dialysis patients, and the area under the curve was 0.807 (95% CI: 0.756～0.857, P＜0.001). Conclusion Age, dialysis age, CRP and TyG index are the independent risk factors for CAC in dialysis patients. TyG index associated with age has a better predictive value for the occurrence of CAC in dialysis patients.
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