目的 探讨终末期肾病(end-stage renal disease，ESRD)拟进入透析患者三酰甘油葡萄糖指数(triglyceride⁃glucose index,TyG)、C反应蛋白(CRP)与血白蛋白(ALB)比值(CRP/ALB)对患者冠状动脉钙化(coronary artery calcification，CAC)诊断价值。 方法 选取2020年1月─2023年12月在首都医科大学附属北京潞河医院肾脏内科住院ESRD拟入透析的患者为研究对象，根据冠状动脉钙化积分将患者分为钙化组和无钙化组。采用Logistic回归分析影响ESRD患者CAC发生的危险因素。绘制受试者工作特征(ROC)曲线，以ROC曲线下面积(AUC)评价TyG、CRP/ALB及两者联合检测对透析患者基线CAC的诊断价值。 结果 纳入研究的303名患者中，钙化组患者182人(60.06%),无钙化组121人。钙化组患者年龄、合并糖尿病比例高于无钙化组(Z/χ2=29.150、8.028，P=0.001、0.005)。钙化组患者TyG (Z=-4.908,P＜0.001)、CRP/ALB(Z=-5.559,P＜0.001)高于无钙化组。多因素Logistic回归分析显示：ESRD患者的年龄(OR=1.030,95% CI：1.006～1.054,P=0.015)、糖尿病(OR=1.747,95% CI：1.039～2.938,P=0.035)、TyG(OR=1.123,95% CI：1.046～1.207,P=0.001)、CRP/ALB(OR=2.307,95% CI：1.475～3.609,P＜0.001)为影响ESRD患者CAC发生的独立危险因素。ROC曲线分析结果显示：ESRD拟入透析患者血清TyG、CRP/ALB及两者联合对患者CAC发生诊断的敏感性分别为0.731、0.692、0.896，特异性分别为 0.570、0.628、0.446，AUC分别为0.666、0.688、0.724，约登指数分别为：0.301、0.320、0.342。 结论 ESRD拟入透析患者血清TyG、CRP/ALB是CAC发生的独立危险因素，且血清TyG、CRP/ALB及两者联合检测对患者CAC的诊断效能较高。
Objective To investigate the relationship between Triglyceride glucose (TyG), C-reactive protein to albumin ratio (CRP/ALB) and coronary artery calcification in patients with end-stage renal disease (ESRD) who were going to start dialysis treatment. Methods Patients with ESRD who were admitted to the Department of Nephrology of our hospital from January 2020 to December 2023 to undergo dialysis were selected as the study objects. The patients were divided into calcification group and non-calcification group according to the coronary score. Logistic regression was used to analyze the risk factors of coronary artery calcification in ESRD patients. Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic value of TyG, CRP/ALB and their combined detection in baseline coronary artery calcification in dialysis patients by area under ROC curve (AUC). Results ①Among the 303 patients included in the study, 182 had vascular calcification (60.06%). The average age of the patients was 61.2 years, with 181 males (59.74%), and 199 patients (65.68%) combined with diabetes. 276 patients (91.09%) had hypertension, and 145 patients (47.85%) were smokers. There were statistically significant differences in age and the proportion of patients with diabetes between the two groups (P＜0.05). ② Comparison of laboratory examination indexes between the two groups: TyG (Z=-4.908, P＜0.001) and CRP/ALB (Z=-5.559, P＜0.001) in the calcification group were higher than those in the non-calcification group. ③Multivariate Logistic regression analysis showed that: The age of the patients with ESRD (OR =1.030, 95% CI：1.006～1.054, P=0.015), diabetes (OR=1.747, 95% CI：1.039～2.938, P=0.035), TyG (OR =1.123, 95% CI：1.046～1.207, P=0.001) and CRP/ALB ratio (OR=2.307, 95% CI：1.475～3.609, P＜0.001) were independent risk factors for coronary calcification in ESRD patients. ④ROC curve analysis results showed that the sensitivity of serum TyG, CRP/ALB and their combination for the diagnosis of coronary artery calcification in ESRD patients undergoing hemodialysis were 0.731, 0.692 and 0.896, and the specificity was 0.570, 0.628 and 0.446, respectively. The AUC was 0.666, 0.688 and 0.724, and the Jorden index was 0.301, 0.320 and 0.342, respectively. Conclusion: Serum TyG and CRP/ALB in ESRD patients undergoing dialysis are independent risk factors for coronary calcification, and serum TyG, CRP/ALB and their combined detection have high diagnostic efficacy in patients with coronary calcification.
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