甘油三酯葡萄糖乘积指数联合肥胖指标对阻塞性睡眠呼吸暂停患者发生非酒精性脂肪性肝病的预测价值

蒋绒; 李永霞

doi:10.3969/j.issn.1001-5256.2023.03.010

甘油三酯葡萄糖乘积指数联合肥胖指标对阻塞性睡眠呼吸暂停患者发生非酒精性脂肪性肝病的预测价值

DOI: 10.3969/j.issn.1001-5256.2023.03.010

蒋绒,
李永霞^, ,

昆明医科大学第二附属医院呼吸与危重症医学科，昆明 650101

基金项目:

昆明医科大学研究生创新基金 (2022S073)

伦理学声明：本研究方案于2022年6月30日经由昆明医科大学第二附属医院医学伦理委员会审查，批号：审-PJ-科-2022-130。

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：李永霞负责文章的构思与设计、研究的实施与可行性分析、论文的修订、对文章整体负责，监督管理；蒋绒负责数据收集、统计学分析、撰写论文。

详细信息

通信作者:
李永霞，yongxiali999@163.com (ORCID：0000-0002-8166-2211)

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出版历程
- 收稿日期: 2022-07-31
- 录用日期: 2022-09-23
- 出版日期: 2023-03-20

Value of triglyceride-glucose index combined with obesity index in predicting nonalcoholic fatty liver disease in individuals with obstructive sleep apnea

Rong JIANG,
Yongxia LI^{,
,}

Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China

Research funding:

Graduate Student Innovation Fund of Kunming Medical University (2022S073)

More Information

Corresponding author: LI Yongxia, yongxiali999@163.com (ORCID: 0000-0002-8166-2211)

摘要

摘要: 目的探讨甘油三酯葡萄糖乘积指数(TyG)、TyG联合BMI及TyG联合腰围(WC)预测阻塞性睡眠呼吸暂停(OSA)患者发生非酒精性脂肪性肝病(NAFLD)的价值。方法回顾性分析2020年1月—2021年12月在昆明医科大学第二附属医院行睡眠呼吸监测并诊断为OSA的患者190例，依据超声检查结果分为OSA合并NAFLD组107例及对照组83例。计量资料两组间比较采用t检验或Mann-Whitney U检验；计数资料两组间比较采用χ²检验。采用二元Logistic回归分析探讨OSA患者发生NAFLD的影响因素。绘制TyG、TyG联合BMI及TyG联合WC预测OSA患者发生NAFLD的受试者工作特征曲线(ROC曲线)，计算曲线下面积(AUC)。AUC的比较采用Z检验。结果与对照组相比，OSA合并NAFLD患者的BMI、颈围、WC、AHI、ODI、ALT、GGT、TG、FPG、TyG较高，年龄、Average SpO₂、LSaO₂、HDL-C较低(P值均＜0.05)。二元Logistic分析显示TyG(OR=1.961，95%CI：1.03~3.73，P=0.040)、BMI(OR=1.203，95%CI：1.03~1.41，P=0.020)、WC(OR=1.074，95%CI：1.01~1.14，P=0.026)为OSA患者发生NAFLD的独立危险因素。TyG、TyG联合BMI及TyG联合WC预测OSA患者发生NAFLD的AUC(95%CI)分别为0.696(0.625~0.760)、0.787(0.722~0.843)和0.803(0.739~0.857)，最佳截断点分别为8.72、0.36和0.60。TyG联合BMI对OSA患者发生NAFLD的预测价值高于TyG(Z=2.542，P=0.011)，TyG联合WC的预测价值也高于TyG(Z=2.976，P=0.002 9)。结论 TyG、TyG联合BMI及TyG联合WC对OSA发生NAFLD具有良好的预测价值，以TyG联合WC的预测价值最佳，有望成为OSA患者发生NAFLD风险的预测指标。
- 睡眠呼吸暂停, 阻塞性 /
- 非酒精性脂肪性肝病 /
- 甘油三酯葡萄糖乘积指数 /
- 人体质量指数 /
- 腰围
Abstract: Objective To investigate the value of triglyceride-glucose index (TyG), TyG combined with body mass index (BMI), and TyG combined with waist circumference (WC) in predicting nonalcoholic fatty liver disease (NAFLD) in patients with obstructive sleep apnea (OSA). Methods A retrospective analysis was performed for 190 patients who underwent sleep respiratory monitoring and were diagnosed with OSA in The Second Affiliated Hospital of Kunming Medical University from January 2020 to December 2021, and according to the results of ultrasonography, they were divided into OSA+NAFLD group with 107 patients and control group with 83 patients. The t-test or the Mann Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The binary logistic regression analysis was used to explore the influencing factors for the development of NAFLD in patients with OSA. The receiver operating characteristic (ROC) curve was plotted for TyG, TyG combined with BMI, and TyG combined with WC in predicting NAFLD in the patients with OSA, and the area under the ROC curve (AUC) was calculated. The Z test was used for comparison of AUC. Results Compared with the control group, the OSA+NAFLD group had significantly higher BMI, neck circumference, WC, apnea-hypopnea index, oxygen desaturation index, alanine aminotransferase, gamma-glutamyltransferase, triglyceride, fasting plasma glucose, and TyG and significantly lower age, average SpO₂, LSaO₂, and high-density lipoprotein cholesterol (all P < 0.05). The binary logistic regression analysis showed that TyG (odds ratio [OR]=1.961, 95% confidence interval [CI]: 1.03-3.73, P=0.04), BMI (OR=1.203, 95%CI: 1.03-1.41, P=0.020), and WC (OR=1.074, 95%CI: 1.01-1.14, P=0.026) were independent risk factors for NAFLD in patients with OSA. TyG, TyG combined with BMI, and TyG combined with WC had an AUC of 0.696 (95%CI: 0.625-0.760), 0.787 (95%CI: 0.722-0.843), and 0.803 (95%CI: 0.739-0.857), respectively, in predicting NAFLD in OSA patients, with an optimal cut-off value of 8.72, 0.36, and 0.60, respectively. TyG combined with BMI had a significantly higher value than TyG in predicting NAFLD in OSA patients (Z=2.542, P=0.011), and TyG combined with WC also had a significantly higher predictive value than TyG (Z=2.976, P=0.002 9). Conclusion TyG, TyG combined with BMI, and TyG combined with WC have a good value in predicting NAFLD in OSA patients, among which TyG combined with WC has the best predictive value and is thus expected to become a predictor for the risk of NAFLD in OSA patients.
- Sleep Apnea, Obstructive /
- Non-alcoholic Fatty Liver Disease /
- Triglyceride-Glucose Index /
- Body Mass Index /
- Waist Circumference

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图 1 TyG、TyG联合BMI及TyG联合WC预测OSA患者发生NAFLD的ROC曲线

Figure 1. ROC curve of TyG、TyG combined with BMI and TyG combined with WC for predicting NAFLD in OSA patients

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表 1 两组患者临床资料比较

Table 1. Comparison of the clinical characteristics between OSA patients with and without NAFLD

指标	对照组 (n=83)	OSA合并NAFLD (n=107)	统计值	P值
男性[例(%)]	48(57.8)	69(64.5)	χ²=0.875	0.350
年龄(岁)	58.05±12.99	53.22±13.37	t=2.498	0.013
BMI(kg/m²)	23.94±3.59	27.77±3.63	t=-7.236	＜0.001
颈围(cm)	37.00(35.00~40.00)	40.00(37.00~43.00)	Z=-4.396	＜0.001
WC(cm)	88.00(84.00~96.00)	102.00(93.50~107.00)	Z=-6.786	＜0.001
AHI(次/h)	32.50(24.60~50.10)	40.60(29.95~64.55)	Z=-2.916	0.004
ODI	24.70(13.50~38.30)	37.30(19.00~56.05)	Z=-2.977	0.003
LSaO₂(%)	79.00(72.00~81.00)	75.00(66.00~79.00)	Z=-2.694	0.007
Average SpO₂(%)	91.10(88.50~92.30)	89.50(87.60~90.80)	Z=-3.567	＜0.001
ALT(U/L)	17.00(12.00~25.00)	21.00(17.00~36.50)	Z=-3.933	＜0.001
AST(U/L)	19.00(16.00~24.00)	20.00(16.00~27.00)	Z=-0.703	0.482
ALP(U/L)	78.00(62.00~90.00)	75.00(64.50~91.00)	Z=-0.748	0.455
GGT(U/L)	24.00(17.00~39.00)	36.00(26.00~55.00)	Z=-4.168	＜0.001
TC(mmol/L)	4.17(3.63~5.28)	4.55(3.75~5.23)	Z=-1.178	0.239
TG(mmol/L)	1.28(0.90~2.03)	1.84(1.35~2.52)	Z=-4.397	＜0.001
HDL-C(mmol/L)	1.12(0.91~1.30)	0.97(0.85~1.11)	Z=-3.506	＜0.001
LDL-C(mmol/L)	2.59(2.25~3.41)	2.89(2.40~3.52)	Z=-1.411	0.158
FPG(mmol/L)	4.99(4.56~5.83)	5.59(4.96~6.78)	Z=-3.012	0.003
TyG	8.69±0.67	9.13±0.59	t=-4.771	＜0.001

下载: 导出CSV

表 2 OSA患者发生NAFLD影响因素的二元logistic回归分析

Table 2. Binary logistic regression analysis of factors influencing the occurrence of NAFLD in OSA patients

指标	Β值	标准误	Wald	OR	95%CI	P值
年龄(岁)	-0.007	0.016	0.164	0.993	0.96~1.03	0.685
BMI(kg/m²)	0.185	0.079	5.455	1.203	1.03~1.41	0.020
颈围(cm)	-0.094	0.070	1.801	0.910	0.79~1.04	0.180
WC(cm)	0.071	0.032	4.951	1.074	1.01~1.14	0.026
AHI(次/h)	0.016	0.020	0.630	1.016	0.98~1.06	0.428
ODI	0.003	0.018	0.031	1.003	0.97~1.04	0.860
LSaO₂(%)	0.020	0.031	0.407	1.020	0.96~1.08	0.524
Average SpO₂(%)	0.064	0.062	1.077	1.066	0.94~1.2	0.299
ALT(U/L)	0.004	0.017	0.055	1.004	0.97~1.04	0.814
GGT(U/L)	0.006	0.008	0.559	1.006	0.99~1.02	0.455
HDL-C(mmol/L)	-0.765	0.906	0.713	0.465	0.08~2.75	0.398
TyG	0.674	0.328	4.229	1.961	1.03~3.73	0.040

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表 3 TyG、TyG联合BMI及TyG联合WC对OSA患者发生NAFLD的预测价值

Table 3. Predictive value of TyG, TyG combined with BMI and TyG combined with WC for OSA patients with NAFLD

指标	最佳截断点	AUC (95%CI)	P值	敏感度 (%)	特异度 (%)	阳性似然比	阴性似然比	约登指数
TyG	8.72	0.696(0.625~0.760)	＜0.001	77.57	56.63	1.79	0.40	0.3420
TyG联合BMI	0.36	0.787(0.722~0.843)	＜0.001	92.52	50.60	1.87	0.15	0.4313
TyG联合WC	0.60	0.803(0.739~0.857)	＜0.001	69.16	78.31	3.19	0.39	0.4747

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参考文献(22)

[1]	BENJAFIELD AV, AYAS NT, EASTWOOD PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis[J]. Lancet Respir Med, 2019, 7(8): 687-698. DOI: 10.1016/S2213-2600(19)30198-5.
[2]	YOUNOSSI ZM, KOENIG AB, ABDELATIF D, et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes[J]. Hepatology, 2016, 64(1): 73-84. DOI: 10.1002/hep.28431.
[3]	UMBRO I, FABIANI V, FABIANI M, et al. Association between non-alcoholic fatty liver disease and obstructive sleep apnea[J]. World J Gastroenterol, 2020, 26(20): 2669-2681. DOI: 10.3748/wjg.v26.i20.2669.
[4]	KHAN SH, SOBIA F, NIAZI NK, et al. Metabolic clustering of risk factors: evaluation of Triglyceride-glucose index (TyG index) for evaluation of insulin resistance[J]. Diabetol Metab Syndr, 2018, 10: 74. DOI: 10.1186/s13098-018-0376-8.
[5]	SONG K, LEE HW, CHOI HS, et al. Comparison of the Modified TyG indices and other parameters to predict non-alcoholic fatty liver disease in youth[J]. Biology (Basel), 2022, 11(5): 685. DOI: 10.3390/biology11050685.
[6]	Sleep Medicine Committee of Chinese Medical Doctor Association. Guidelines for multidisciplinary diagnosis and treatment of adult obstructive sleep apnea[J]. Natl Med J China, 2018, 98(24): 1902-1914. DOI: 10.3760/cma.j.issn.0376-2491.2018.24.003. 中国医师协会睡眠医学专业委员会. 成人阻塞性睡眠呼吸暂停多学科诊疗指南[J]. 中华医学杂志, 2018, 98(24): 1902-1914. DOI: 10.3760/cma.j.issn.0376-2491.2018.24.003.
[7]	National Workshop on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology, Chinese Medical Association; Fatty Liver Expen Committee, Chinese Medical Doctor Association. Guidelines of prevention and treatment for nonalcoholic fatty liver disease: A 2018 update[J]. J Clin Hepatol, 2018, 34(5): 947-957. DOI: 10.3969/j.issn.1001-5256.2018.05.007. 中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会. 非酒精性脂肪性肝病防治指南(2018年更新版)[J]. 临床肝胆病杂志, 2018, 34(5): 947-957. DOI: 10.3969/j.issn.1001-5256.2018.05.007.
[8]	SIMENTAL-MENDÍA LE, RODRÍGUEZ-MORÁN M, GUERRERO-ROMERO F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects[J]. Metab Syndr Relat Disord, 2008, 6(4): 299-304. DOI: 10.1089/met.2008.0034.
[9]	DELONG ER, DELONG DM, CLARKE-PEARSON DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach[J]. Biometrics, 1988, 44(3): 837-845.
[10]	MESARWI OA, LOOMBA R, MALHOTRA A. Obstructive sleep apnea, hypoxia, and nonalcoholic fatty liver disease[J]. Am J Respir Crit Care Med, 2019, 199(7): 830-841. DOI: 10.1164/rccm.201806-1109TR.
[11]	JIN S, JIANG S, HU A. Association between obstructive sleep apnea and non-alcoholic fatty liver disease: a systematic review and meta-analysis[J]. Sleep Breath, 2018, 22(3): 841-851. DOI: 10.1007/s11325-018-1625-7.
[12]	CHEN LD, ZHANG LJ, LIN XJ, et al. Association between continuous positive airway pressure and serum aminotransferases in patients with obstructive sleep apnea[J]. Eur Arch Otorhinolaryngol, 2018, 275(2): 587-594. DOI: 10.1007/s00405-017-4840-0.
[13]	CAKMAK E, DUKSAL F, ALTINKAYA E, et al. Association between the severity of nocturnal hypoxia in obstructive sleep apnea and non-alcoholic fatty liver damage[J]. Hepat Mon, 2015, 15(11): e32655. DOI: 10.5812/hepatmon.32655.
[14]	LIU YR, WEN XH, GAO M, et al. Correlation between atherogenic index of plasma and nonalcoholic fatty liver disease in non-obese populations[J]. Clin Misdiagn Misther, 2021, 34(10): 100-104. DOI: 10.3969/j.issn.1002-3429.2021.10.021. 刘艳如, 温晓华, 高冕, 等. 非肥胖人群血浆致动脉硬化指数与非酒精性脂肪性肝病的相关性[J]. 临床误诊误治, 2021, 34(10): 100-104. DOI: 10.3969/j.issn.1002-3429.2021.10.021.
[15]	BETTINI S, SERRA R, FABRIS R, et al. Association of obstructive sleep apnea with non-alcoholic fatty liver disease in patients with obesity: an observational study[J]. Eat Weight Disord, 2021, 27(1): 335-343. DOI: 10.1007/s40519-021-01182-9.
[16]	FU YM, WANG CY, LI ZB, et al. Diagnostic efficiency of controlled attenuation parameter on hepatic steatosis of patients with nonalcoholic fatty liver disease[J]. Med J Chin PLA, 2022, 47(6): 593-598. DOI: 10.11855/j.issn.0577-7402.2022.06.0593. 付懿铭, 王春艳, 李忠斌, 等. 受控衰减参数对非酒精性脂肪性肝病患者肝脂肪变性分级的诊断价值[J]. 解放军医学杂志, 2022, 47(6): 593-598. DOI: 10.11855/j.issn.0577-7402.2022.06.0593.
[17]	STAREKOVA J, HERNANDO D, PICKHARDT PJ, et al. Quantification of liver fat content with CT and MRI: State of the art[J]. Radiology, 2021, 301(2): 250-262. DOI: 10.1148/radiol.2021204288.
[18]	ER LK, WU S, CHOU HH, et al. Triglyceride glucose-body mass index is a simple and clinically useful surrogate marker for insulin resistance in nondiabetic individuals[J]. PLoS One, 2016, 11(3): e0149731. DOI: 10.1371/journal.pone.0149731.
[19]	LEE SB, KIM MK, KANG S, et al. Triglyceride glucose index is superior to the homeostasis model assessment of insulin resistance for predicting nonalcoholic fatty liver disease in Korean adults[J]. Endocrinol Metab (Seoul), 2019, 34(2): 179-186. DOI: 10.3803/EnM.2019.34.2.179.
[20]	KIM HS, CHO YK, KIM EH, et al. Triglyceride glucose-waist circumference is superior to the homeostasis model assessment of insulin resistance in identifying nonalcoholic fatty liver disease in healthy subjects[J]. J Clin Med, 2021, 11(1): 41. DOI: 10.3390/jcm11010041.
[21]	KHAMSEH ME, MALEK M, ABBASI R, et al. Triglyceride glucose index and related parameters (triglyceride glucose-body mass index and triglyceride glucose-waist circumference) identify nonalcoholic fatty liver and liver fibrosis in individuals with overweight/obesity[J]. Metab Syndr Relat Disord, 2021, 19(3): 167-173. DOI: 10.1089/met.2020.0109.
[22]	FERRAIOLI G, SOARES MONTEIRO LB. Ultrasound-based techniques for the diagnosis of liver steatosis[J]. World J Gastroenterol, 2019, 25(40): 6053-6062. DOI: 10.3748/wjg.v25.i40.6053.