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.
WANG Zhi-Juan
,
LI Huan
,
LIU Gui-Ling
. The relationship between serum triglyceride glucose index and coronary artery calcification in dialysis patients [J]. Chinese Journal of Blood Purification, 2022
, 21(06)
: 403
-407
.
DOI: 10.3969/j.issn.1671-4091.2022.06.005
[1]Weiner DE, Tighiouart H, Amin MG, et al. Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies[J].?J Am Soc Nephrol. 2004;15(5):1307-1315.
[2]Bolland MJ, Wang TK, van Pelt NC, et al. Abdominal aortic calcification on vertebral morphometry images predicts incident myocardial infarction[J].?J Bone Miner Res.
2010;25(3):505-512.
[3]Wang XR, Zhang JJ, Xu XX, et al. Prevalence of coronary artery calcification and its association with mortality, cardiovascular events in patients with chronic kidney disease: a systematic review and meta-analysis[J].?Ren Fail. 2019;41(1):244-256.
[4]Noce A, Canale MP, Capria A, et al. Coronary artery calcifications predict long term cardiovascular events in non diabetic Caucasian hemodialysis patients[J].?Aging (Albany NY). 2015;7(4):269-279.
[5]Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone?Disorder (CKD-MBD)[J].?Kidney Int Suppl (2011). 2017;7(1):1-59.
[6]Chamroonkiadtikun P, Ananchaisarp T, Wanichanon W. The triglyceride-glucose index, a predictor of type 2 diabetes development: A retrospective cohort study[J].Prim Care Diabetes. 2020;14(2):161-167.
[7]Rehman K, Akash MS. Mechanisms of inflammatory responses and development of insulin resistance: how are they interlinked?[J].J Biomed Sci. 2016;23(1):87.
[8]Ormazabal V, Nair S, Elfeky O, et al. Association between insulin resistance and the development of cardiovascular disease[J].Cardiovasc Diabetol. 2018;17(1):122.
[9]Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography[J].?J Am Coll Cardiol. 1990;15(4):827-832.
[10]Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups[J].?N Engl J Med. 2008;358(13):1336-1345.
[11]Budoff MJ, Hokanson JE, Nasir K, et al. Progression of coronary artery calcium predicts all-cause mortality[J].?JACC Cardiovasc Imaging. 2010;3(12):1229-1236.
[12]Nasir K, Bittencourt MS, Blaha MJ, et al. Implications of coronary artery calcium testing among statin candidates according to American College of Cardiology/American heart association cholesterol management guidelines[J]. J Am Coll Cardiol 2015;66:1657–68.
[13]Shimoyama Y, Tsuruta Y, Niwa T. Coronary artery calcification score is associated with mortality in Japanese hemodialysis patients[J].?J Ren Nutr. 2012;22(1):139-142.
[14]Aroor AR, Mandavia CH, Sowers JR. Insulin resistance and heart failure: molecular mechanisms[J].?Heart Fail Clin. 2012;8(4):609-617.
[15]Marsico F, Gargiulo P, Marra AM, Parente A, Paolillo S. Glucose Metabolism Abnormalities in Heart Failure Patients: Insights and Prognostic Relevance[J].?Heart Fail Clin. 2019;15(3):333-340.
[16]Rask-Madsen C, Li Q, Freund B, et al. Loss of insulin signaling in vascular endothelial cells accelerates atherosclerosis in apolipoprotein E null mice[J].Cell Metab. 2010;11(5):379-389.
[17]Reardon CA, Lingaraju A, Schoenfelt KQ, et al. Obesity and Insulin Resistance Promote Atherosclerosis through an IFNγ-Regulated Macrophage Protein Network[J].Cell Rep. 2018;23(10):3021-3030.
[18]龚冰璐,黄红漫,许其倓.胰岛素抵抗性心肌病[J].心血管病学进展,2009,30(02):263-265.
[19]Park K, Ahn CW, Lee SB, et al. Elevated TyG Index Predicts Progression of Coronary Artery Calcification[J].?Diabetes Care. 2019;42(8):1569-1573.
[20]Stenvinkel P, Luttropp K, McGuinness D, et al.?CDKN2A/p16INK4a?expression is associated with vascular progeria in chronic kidney disease[J].Aging (Albany NY). 2017;9(2):494-507.
[21]Carson AP, Steffes MW, Carr JJ, et al. Hemoglobin a1c and the progression of coronary artery calcification among adults without diabetes[J].Diabetes Care. 2015;38(1):66-71.
[22]Henze LA, Luong TTD, Boehme B, et al. Impact of C-reactive protein on osteo-/chondrogenic transdifferentiation and calcification of vascular smooth muscle cells[J].Aging (Albany NY). 2019;11(15):5445-5462.
[23]Chen H, Han X, Cui Y,et al. Parathyroid Hormone Fragments: New Targets for the Diagnosis and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder[J].Biomed Res Int. 2018;2018:9619253.