甘油三酯<b>-</b>葡萄糖指数和同型半胱氨酸与中老年<b>2</b>型糖尿病人群脑卒中发病风险的关联

刘晓琳; 张金; 李智韬; 王小楠; 柯居中; 吴抗; 邱桦; 刘庆平; 宋家慧; 高娇娇; 刘杨; 徐倩; 周弋; 阮晓楠

doi:10.19428/j.cnki.sjpm.2025.24714

甘油三酯-葡萄糖指数和同型半胱氨酸与中老年2型糖尿病人群脑卒中发病风险的关联

Triglyceride-glucose index and homocysteine in association with the risk of stroke in middle-aged and elderly diabetic populations

摘要

摘要:
目的探讨2型糖尿病（T2DM）患者中甘油三酯⁃葡萄糖（TyG）指数和血清同型半胱氨酸（Hcy）水平与脑卒中发病的相关性。
方法基于上海市浦东新区慢性病危险因素监测队列，排除基线已患脑卒中者，以2016年1月—2020年10月入组队列的T2DM患者作为研究对象，将在随访期确认新发缺血性脑卒中的318名研究对象作为病例组，并根据性别进行1∶1匹配318名未发生脑卒中者为对照组，通过Cox比例风险回归模型调整混杂因素后，探索血清中TyG指数、Hcy与脑卒中发病风险的关系。
结果 Cox回归模型显示，调整混杂因素后，10 μmol·L^-1<Hcy≤15 μmol·L^-1与Hcy>15 μmol·L^-1的T2DM患者发生脑卒中风险分别为Hcy≤10 μmol·L^-1者的1.532倍（95%CI为1.017~2.309，P=0.041）和1.738倍（95%CI为1.119~2.699，P=0.014）；TyG>9.074的T2DM患者发生脑卒中风险是TyG≤9.074者的1.396倍（95%CI为1.091~1.787，P=0.008）；血清尿素（UREA）与α1‑抗胰蛋白酶（α1‑AT）是T2DM患者并发脑卒中的独立危险因素， α1‑AT与UREA每增加1个单位，T2DM患者并发脑卒中的风险分别增加233.6%（HR=3.336，95%CI为1.588~7.009，P=0.001）和11.3%（HR=1.113，95%CI为1.028~1.205，P=0.008）。累积风险曲线显示：Hcy>10 μmol·L^-1和TyG>9.074可加快T2DM患者发生脑卒中的时间。
结论 T2DM患者Hcy>10 μmol·L^-1以及TyG指数偏高是并发脑卒中危险因素，应针对T2DM患者进行Hcy和TyG的有效干预，减少脑卒中的发生。

Abstract:
Objective To investigate the triglyceride-glucose (TyG) index and the level of serum homocysteine (Hcy) in association with the incidence of stroke in type 2 diabetes mellitus (T2DM) patients.
Methods Based on the chronic disease risk factor surveillance cohort in Pudong New Area, Shanghai, excluding those with stroke in baseline survey, T2DM patients who joined the cohort from January 2016 to October 2020 were selected as the research subjects. During the follow-up period, a total of 318 new-onset ischemic stroke patients were selected as the case group, and a total of 318 individuals matched by gender without stroke were selected as the control group. The Cox proportional hazards regression model was used to adjust for confounding factors and explore the serum TyG index and the Hcy biochemical indicator in association with the risk of stroke.
Results The Cox proportional hazards regression results showed that after adjusting for confounding factors, the risk of stroke in T2DM patients with 10 μmol·L⁻¹<Hcy≤15 μmol·L^-¹ and Hcy>15 μmol·L⁻¹ was 1.532 times (95%CI: 1.017‒2.309 times, P=0.041) and 1.738 times (95%CI: 1.119‒2.699 times, P=0.014) higher respectively, compared to T2DM patients with Hcy≤10 μmol·L⁻¹. T2DM patients with TyG>9.074 had 1.396 times higher risk of stroke (95%CI: 1.091‒1.787, P=0.008) compared to those with TyG≤9.074. The study found that urea and α1-antitrypsin (α1-AT) were independent risk factors for the incidence of stroke in T2DM patients. For every unit increase in urea and α1-AT, the risk of stroke in T2DM patients increased by 233.6% (HR=3.336, 95%CI: 1.588‒7.009, P=0.001) and 11.3% (HR=1.113, 95%CI: 1.028‒1.205, P=0.008), respectively. Cumulative risk curves showed that Hcy>10 μmol·L⁻¹ and TyG>9.074 accelerated the time to stroke occurrence in T2DM patients.
Conclusion Elevated levels of Hcy>10 μmol·L⁻¹ and a higher TyG index are risk factors for stroke in T2DM patients. Effective interventions for Hcy and TyG should be conducted for diabetic patients to reduce the incidence of stroke.

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