TyG-BMI、HAR、GRI与糖尿病视网膜病变的关系

doi:10.11958/20241485

天津医药 ›› 2025, Vol. 53 ›› Issue (1): 93-97.doi: 10.11958/20241485

TyG-BMI、HAR、GRI与糖尿病视网膜病变的关系

隋源(), 姜冰冰, 勾晓梅, 孙敬文, 张成森()

哈尔滨二四二医院（邮编150000）

收稿日期:2024-10-09 修回日期:2024-11-27 出版日期:2025-01-15 发布日期:2025-02-06
通讯作者: ^△E-mail：492229374@qq.com
作者简介:隋源（1978），女，副主任医师，主要从事眼底和眼表疾病研究。E-mail：1557654959@qq.com
基金资助:
黑龙江省卫生健康委科研课题(20220707020638)

The relationship between triglyceride glucose body mass index, high density lipoprotein cholesterol to apolipoprotein A ratio, glycemic risk index and diabetic retinopathy

SUI Yuan(), JIANG Bingbing, GOU Xiaomei, SUN Jingwen, ZHANG Chengsen()

Harbin 242 Hospital, Harbin 150000, China

Received:2024-10-09 Revised:2024-11-27 Published:2025-01-15 Online:2025-02-06
Contact: ^△E-mail：492229374@qq.com

隋源, 姜冰冰, 勾晓梅, 孙敬文, 张成森. TyG-BMI、HAR、GRI与糖尿病视网膜病变的关系[J]. 天津医药, 2025, 53(1): 93-97.

SUI Yuan, JIANG Bingbing, GOU Xiaomei, SUN Jingwen, ZHANG Chengsen. The relationship between triglyceride glucose body mass index, high density lipoprotein cholesterol to apolipoprotein A ratio, glycemic risk index and diabetic retinopathy[J]. Tianjin Medical Journal, 2025, 53(1): 93-97.

摘要/Abstract

摘要：

目的探讨甘油三酯葡萄糖体重指数（TyG-BMI）、高密度脂蛋白胆固醇与载脂蛋白A比值（HAR）、血糖风险指数（GRI）与糖尿病视网膜病变（DR）的关系。方法将159例2型糖尿病（T2DM）并发DR患者（DR组）根据DR国际临床分级标准分为非增殖期视网膜病变组（NPDR组，66例）和增殖期视网膜病变组（PDR组，93例），另择159例未发生DR的T2DM患者为对照组。记录临床信息和基线实验室检查结果，计算TyG-BMI、HAR、GRI。多因素Logistic回归分析DR发病的影响因素，受试者工作特征（ROC）曲线分析TyG-BMI、HAR、GRI对DR的诊断价值。结果 DR组T2DM病程，合并高血压、糖尿病肾病、糖尿病足比例，糖化血红蛋白（HbA1c）、稳态模型胰岛素抵抗指数（HOMA-IR）、总胆固醇（TC）、C反应蛋白（CRP）、TyG-BMI、HAR和GRI水平均高于对照组（P<0.05）。PDR组TyG-BMI、HAR和GRI均高于NPDR组（P<0.05）。多因素Logistic回归分析结果显示，T2DM病程较长[OR（95%CI）：2.781（1.398~5.534）]、高TyG-BMI[2.036（1.169~3.546）]、高HAR[1.890（1.090~3.280）]、高GRI[1.836（1.065~3.167）]是DR患病的危险因素（P<0.05）。ROC曲线分析结果显示，联合TyG-BMI、HAR、GRI诊断DR的曲线下面积（AUC）高于单独诊断[分别为0.940（0.908~0.964）、0.864（0.821~0.900）、0.796（0.747~0.839）、0.836（0.790~0.875），均P<0.05]。结论 T2DM患者TyG-BMI、HAR、GRI增高与DR发病及病情严重程度有关，可用于评估DR的发病风险。

关键词: 糖尿病视网膜病变, 甘油三酯葡萄糖体重指数, 高密度脂蛋白胆固醇与载脂蛋白A比值, 血糖风险指数

Abstract:

Objective To investigate the relationship between triglyceride glucose body mass index (TyG-BMI), high density lipoprotein cholesterol to Apolipoprotein A ratio (HAR), glycemic risk index (GRI) and diabetic retinopathy (DR).Methods A total of 159 patients with type 2 diabetes mellitus (T2DM) complicated with DR (the DR group) were divided into the non-proliferative retinopathy group (NPDR group, 66 cases) and the proliferative retinopathy group (PDR group, 93 cases) according to DR international clinical grading criteria, and 159 T2DM patients without DR were selected as the control group. Clinical information and baseline laboratory test results were recorded, and TyG-BMI, HAR and GRI were calculated. Multivariate Logistic regression analysis was conducted to analyze the related factors of the incidence of DR, and receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of TyG-BMI, HAR and GRI for DR.Results The duration of T2DM, the proportion of hypertension, diabetic nephropathy and diabetic foot, levels of HbA1c, homeostasis model insulin resistance index (HOMA-IR), total cholesterol (TC), C-reactive protein (CRP), TyG-BMI, HAR and GRI were higher in the DR group than those in the control group (P < 0.05). TyG-BMI, HAR and GRI were higher in the PDR group than those in the NPDR group (P < 0.05). Multivariate Logistic regression analysis showed that the longer course of T2DM disease [OR (95%CI) : 2.781 (1.398-5.534)], high TyG-BMI [2.036 (1.169-3.546)], high HAR [1.890 (1.090-3.280)] and high GRI [1.836 (1.065-3.167)] were risk factors for DR (P < 0.05). ROC curve analysis results showed that, the area under the curve (AUC) of combined TyG-BMI, HAR and GRI diagnosis of DR was higher than that of single diagnosis [0.940 (0.908-0.964), 0.864 (0.821-0.900), 0.796 (0.747-0.839) and 0.836 (0.790-0.875), all P < 0.05].Conclusion The increased TyG-BMI, HAR and GRI in T2DM patients is associated with the onset and severity of DR, and which can be used to assess the risk of DR.

Key words: diabetic retinopathy, triglyceride glucose body mass index (TyG-BMI), high-density lipoprotein cholesterol to apolipoprotein A ratio (HAR), glycemic risk index (GRI)

中图分类号:

R587.29

图/表 6

参考文献 25

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组别		n	年龄/岁		男性		BMI/（kg/m²）		T2DM病程/年		高血压		高脂血症		糖尿病肾病		糖尿病足
对照组		159	56.05±11.38		90（56.60）		23.06±1.87		4.74±1.89		92（57.86）		73（45.91）		19（11.95）		10（6.29）
DR组		159	56.29±12.12		96（60.37）		23.21±1.92		7.40±2.10		117（73.58）		80（50.31）		43（27.04）		26（16.35）
t或χ²			0.181		0.466		0.696		11.836^＊＊		8.724^＊＊		0.617		11.540^＊＊		8.019^＊＊
组别	HbA1c/%			HOMA-IR		TC/（mmol/L）		CRP/（mg/L）		WBC/（×10⁹/L）		NEU/（×10⁹/L）		Scr/（μmol/L）		Hcy/（μmol/L）
对照组	7.15±1.65			2.99±1.24		5.20±0.45		9.30±2.30		10.17±2.32		6.52±1.78		69.90±8.93		8.71±2.06
DR组	8.90±2.08			3.66±1.71		5.61±0.68		11.50±2.73		10.56±2.51		6.63±1.89		72.38±10.66		9.15±2.06
t	8.319^＊＊			3.973^＊＊		6.311^＊＊		7.627^＊＊		1.440		0.516		1.250		1.899

组别		n	年龄/岁		男性		BMI/（kg/m²）		T2DM病程/年		高血压		高脂血症		糖尿病肾病		糖尿病足
对照组		159	56.05±11.38		90（56.60）		23.06±1.87		4.74±1.89		92（57.86）		73（45.91）		19（11.95）		10（6.29）
DR组		159	56.29±12.12		96（60.37）		23.21±1.92		7.40±2.10		117（73.58）		80（50.31）		43（27.04）		26（16.35）
t或χ²			0.181		0.466		0.696		11.836^＊＊		8.724^＊＊		0.617		11.540^＊＊		8.019^＊＊
组别	HbA1c/%			HOMA-IR		TC/（mmol/L）		CRP/（mg/L）		WBC/（×10⁹/L）		NEU/（×10⁹/L）		Scr/（μmol/L）		Hcy/（μmol/L）
对照组	7.15±1.65			2.99±1.24		5.20±0.45		9.30±2.30		10.17±2.32		6.52±1.78		69.90±8.93		8.71±2.06
DR组	8.90±2.08			3.66±1.71		5.61±0.68		11.50±2.73		10.56±2.51		6.63±1.89		72.38±10.66		9.15±2.06
t	8.319^＊＊			3.973^＊＊		6.311^＊＊		7.627^＊＊		1.440		0.516		1.250		1.899

组别	n	TyG-BMI	HAR	GRI
对照组	159	153.44±28.43	0.75±0.19	26.33±4.05
DR组	159	164.62±40.79	0.91±0.22	33.85±6.21
t		2.835^＊＊	6.583^＊＊	12.795^＊＊

组别	n	TyG-BMI	HAR	GRI
对照组	159	153.44±28.43	0.75±0.19	26.33±4.05
DR组	159	164.62±40.79	0.91±0.22	33.85±6.21
t		2.835^＊＊	6.583^＊＊	12.795^＊＊

组别	n	TyG-BMI	HAR	GRI
NPDR组	66	156.59±11.30	0.78±0.19	31.38±3.67
PDR组	93	167.77±13.67	0.98±0.14	35.39±2.94
t		5.456^＊＊	7.752^＊＊	7.632^＊＊

TyG-BMI、HAR、GRI与糖尿病视网膜病变的关系

The relationship between triglyceride glucose body mass index, high density lipoprotein cholesterol to apolipoprotein A ratio, glycemic risk index and diabetic retinopathy

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变量	β	SE	Wald χ²	P	OR（95%CI）
T2DM病程	1.023	0.351	8.494	<0.001	2.781（1.398~5.534）
TyG-BMI	0.711	0.283	6.311	<0.001	2.036（1.169~3.546）
HAR	0.637	0.281	5.138	0.003	1.890（1.090~3.280）
GRI	0.608	0.278	4.783	0.009	1.836（1.065~3.167）
常数项	11.685	3.241	12.998	<0.001	118 776.636

指标	AUC（95%CI）	临界值	敏感度/%	特异度/%	约登指数
TyG-BMI	0.864（0.821~0.900）	161.54	79.87	81.76	0.616
HAR	0.796（0.747~0.839）	0.82	78.62	83.02	0.616
GRI	0.836（0.790~0.875）	29.83	81.13	83.65	0.648
联合	0.940（0.908~0.964）	-	96.23	80.50	0.767

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