背景:TyG指数是胰岛素抵抗(IR)的指标,这与心血管疾病的发展和预后有关。本研究旨在总结TyG指数与风险的关系,严重程度,和冠状动脉疾病(CAD)的预后进行系统评价和荟萃分析。
方法:PubMed,EMBASE,科克伦图书馆,和WebofScience数据库搜索了从成立到2023年5月1日发表的文章。横断面研究,纳入了招募CAD患者的回顾性或前瞻性队列研究.对于CAD严重程度的分析,结果为冠状动脉钙化,冠状动脉狭窄,冠状动脉斑块进展,多血管CAD,和支架内再狭窄。对于CAD预后的分析,主要结局是主要不良心血管事件(MACE).
结果:本研究包括41项研究。与TyG指数最低的患者相比,TyG指数最高的人有更高的CAD风险[比值比(OR):1.94,95%置信区间(CI)1.20-3.14,I2=91%,P=0.007]。此外,这些患者更可能有狭窄的冠状动脉(OR:3.49,95%CI1.71-7.12,I2=0%,P=0.0006),进展斑块(OR:1.67,95%CI1.28-2.19,I2=0%,P=0.002),并且涉及更多的血管(OR:2.33,95%CI1.59-3.42,I2=0%,P<0.0001)。当作为分类变量计算时,看来,TyG指数水平较高的急性冠脉综合征(ACS)患者可能具有较高的MACE发生率[风险比(HR):2.09,95%CI1.68-2.62,I2=87%,P<0.00001],而TyG指数水平较高的慢性冠脉综合征(CCS)或稳定型冠心病患者表现出MACE发生率增加的趋势(HR:1.24,95%CI0.96-1.60,I2=85%,P=0.09)。当作为连续变量计算时,ACS患者的HR为每1单位/1标准差增加的TyG指数为2.28(95%CI1.44-3.63,I2=95%,P=0.0005)。同样,CCS或稳定的CAD患者的HR为每1单位/1标准差增加的TyG指数为1.49(95%CI1.21-1.83,I2=75%,P=0.0001)。非阻塞性冠状动脉心肌梗死患者每增加1个单位的TyG指数,HR为1.85(95%CI1.17-2.93,P=0.008)。
结论:TyG指数是一种简单的新综合指数,已被证明是CAD患者全程管理的有价值的工具。TyG指数水平较高的患者患CAD的风险较高,更严重的冠状动脉病变,与TyG指数水平较低的患者相比,预后较差。
The TyG index is an indicator of insulin resistance (IR), which is associated with the development and prognosis of cardiovascular disease. This study aimed to summarize the relationship between the TyG index and the risk, severity, and prognosis of coronary artery disease (CAD) by performing a systematic
review and meta-analysis.
The PubMed, EMBASE, The Cochrane Library, and Web of Science databases were searched for articles published from inception until May 1, 2023. Cross-sectional studies, retrospective or prospective cohort studies recruiting patients with CAD were included. For the analysis of CAD severity, the outcomes were coronary artery calcification, coronary artery stenosis, coronary plaque progression, multi-vessel CAD, and in-stent re-stenosis. For the analysis of CAD prognosis, the primary outcome was major adverse cardiovascular events (MACE).
Forty-one studies were included in this study. Compared to patients with the lowest TyG index, those with the highest TyG index had a higher CAD risk [odds ratio (OR): 1.94, 95% confidence interval (CI) 1.20-3.14, I2 = 91%, P = 0.007]. Additionally, these patients were more likely to have stenotic coronary arteries (OR: 3.49, 95% CI 1.71-7.12, I2 = 0%, P = 0.0006), progressed plaques (OR: 1.67, 95% CI 1.28-2.19, I2 = 0%, P = 0.002), and with more vessels involved (OR: 2.33, 95% CI 1.59-3.42, I2 = 0%, P < 0.0001). When calculated as a categorized variable, it appears that acute coronary syndrome (ACS) patients with higher TyG index levels may have a higher incidence rate of MACE [hazard ratio (HR): 2.09, 95% CI 1.68-2.62, I2 = 87%, P < 0.00001], whereas chronic coronary syndrome (CCS) or stable CAD patients with higher TyG index levels showed a trend towards an increased incidence rate of MACE (HR: 1.24, 95% CI 0.96-1.60, I2 = 85%, P = 0.09). When calculated as a continuous variable, ACS patients had an HR of 2.28 per 1-unit/1-standard deviation increment of the TyG index (95% CI 1.44-3.63, I2 = 95%, P = 0.0005). Similarly, CCS or stable CAD patients had an HR of 1.49 per 1-unit/1-standard deviation increment of the TyG index (95% CI 1.21-1.83, I2 = 75%, P = 0.0001). Myocardial infarction with non-obstructive coronary arteries patients had an HR of 1.85 per 1-unit increment of the TyG index (95% CI 1.17-2.93, P = 0.008).
The TyG index is a simple new synthetic index that has been proven to be a valuable tool in the whole-course management of CAD patients. Patients with higher TyG index levels are at a higher risk of CAD, more severe coronary artery lesions, and worse prognosis compared to those with lower TyG index levels.