甘油三酯-葡萄糖（TyG）指数与女性胆囊结石的相关性分析

章帅; 刘军; 史茜菁; 吴阳; 梁好; 董浩; 陆戴龙; 朱滢

doi:10.12449/JCH250727

甘油三酯-葡萄糖（TyG）指数与女性胆囊结石的相关性分析

DOI: 10.12449/JCH250727

章帅¹,
刘军¹,
史茜菁¹,
吴阳¹,
梁好²,
董浩³,
陆戴龙⁴,
朱滢^1, , ,

1.
扬州大学附属苏北人民医院消化内科，江苏扬州 225001
2.
扬州大学附属苏北人民医院心血管内科，江苏扬州 225001
3.
扬州大学附属苏北人民医院肝胆外科，江苏扬州 225001
4.
扬州大学附属苏北人民医院胃肠外科，江苏扬州 225001

基金项目:

江苏省基础研究计划（自然科学基金）青年基金项目 (BK20240489);

江苏省中医药科技发展计划面上项目 (MS2023138)

伦理学声明：本研究方案于2024年2月6日经由扬州大学附属苏北人民医院伦理审查委员会审批，批号：2024ky024，患者均签署知情同意书。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：章帅负责统计学分析，设计论文框架，起草论文；梁好负责统计学分析，绘制图表；史茜菁、吴阳、董浩、陆戴龙负责数据收集；刘军负责论文修改；朱滢负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
朱滢， bujingzhuying@126.com （ORCID： 0000-0001-9880-5330）

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出版历程
- 收稿日期: 2024-12-27
- 录用日期: 2025-01-14
- 出版日期: 2025-07-25

Association between triglyceride-glucose index and gallstones in women： A cross-sectional study

1.
Department of Gastroenterology, Subei People’s Hospital Affiliated to Yangzhou University，Yangzhou，Jiangsu 225001，China
2.
Department of Cardiology, Subei People’s Hospital Affiliated to Yangzhou University，Yangzhou，Jiangsu 225001，China
3.
Department of Hepatobiliary Surgery, Subei People’s Hospital Affiliated to Yangzhou University，Yangzhou，Jiangsu 225001，China
4.
Department of Gastrointestinal Surgery, Subei People’s Hospital Affiliated to Yangzhou University，Yangzhou，Jiangsu 225001，China

Research funding:

Jiangsu Basic Research Program （Natural Science Foundation） Youth Fund Project (BK20240489);

Jiangsu Traditional Chinese Medicine Science and Technology Development Plan General Project (MS2023138)

More Information

Corresponding author: ZHU Ying， bujingzhuying@126.com （ORCID： 0000-0001-9880-5330）

摘要

摘要: 目的本研究旨在探讨甘油三酯-葡萄糖（TyG）指数与女性胆囊结石患病之间的关联性，并评估其作为女性胆囊结石流行病学筛查指标的可行性。方法选择苏北人民医院2021年1月—2023年6月体检的22 979例成年女性，根据腹部彩色多普勒超声仪报告结果将参与者分成胆囊结石组（n=1 763）和非胆囊结石组（n=21 216）。对于符合正态分布的计量资料两组间对比采用成组t检验；非正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ²检验。多因素Logistic回归分析、限制性立方样条分析、亚组分析与中介效应被用于探讨TyG与女性胆囊结石患病风险之间的关联性。结果女性胆囊结石总体患病率为7.7%。胆囊结石组的年龄、BMI、空腹血糖、TG、TyG指数、TC、Hb、尿素氮、尿酸、血肌酐、TBil、LDL-C水平均高于非胆囊结石组（P值均<0.05），且患有糖尿病、脂肪肝、高血压和高尿酸血症的女性体检人群更易患有胆囊结石（P值均<0.05）。多因素Logistic回归显示，TyG指数四分位组中Q3（8.97～9.38）和Q4（≥9.38）组胆囊结石患病风险分别是Q1（<8.63）组的1.38倍（95%CI：1.15～1.62，P<0.001）和1.39倍（95%CI：1.16～1.68，P<0.001）。调整所有协变量后，TyG指数连续变量也显示与胆囊结石患病风险呈独立正相关（OR=1.24，95%CI：1.11～1.39，P=0.004）。限制性立方样条曲线揭示了TyG指数与胆囊结石发生风险之间存在显著非线性关联（P for nonlinear=0.008），且阈值分析显示，TyG指数在拐点8.95以下部分的效应具有显著统计学意义（OR=1.34，95%CI：1.15～1.97，P=0.042）。亚组分析显示，BMI<25 kg/m²、年龄<50岁、年龄≥50岁、无糖尿病、无脂肪肝、TC<5.72 mmol/L、TBil<21 μmol/L、Hb 110～150 g/L、BUN<7.5 μmol/L、有高血压、无高血压的女性人群中，其TyG指数与胆囊结石之间呈显著正相关（P值均<0.05）。对交互作用P值具有统计学意义的亚组进行了中介分析，结果显示，在TyG指数对胆囊结石的影响中，BMI占中介效应的23.0%，脂肪肝占15.7%，糖尿病占21.0%。结论在女性人群中，较高的TyG指数提示更高的胆囊结石风险。降低TyG指数或许可以通过改善胰岛素敏感性，从而减少胆囊结石的风险。
- 甘油三酯葡萄糖指数 /
- 胆囊结石 /
- 胰岛素抵抗 /
- 横断面研究
Abstract: Objective To investigate the association between triglyceride-glucose （TyG） index and the prevalence of gallstones in women， and to assess whether it can be used as a convenient indicator for the epidemiological survey of gallstones in women. Methods A total of 22 979 adult women who underwent physical examination in Subei People’s Hospital of Jiangsu from January 2021 to June 2023 were enrolled， and according to the results of abdominal color Doppler ultrasound， they were divided into gallstone group with 1 763 women and non-gallstone group with 21 216 women. The independent samples t-test was used for comparison of normally distributed continuous data between groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups； the chi-square test was used for comparison of categorical data between groups. The multivariate logistic regression analysis， the restricted cubic spline analysis， the subgroup analysis， and mediating effect were used to investigate the association between TyG index and the risk of gallstones in women. Results The overall prevalence rate of gallstones was 7.7% in women. Compared with the non-gallstone group， the gallstone group had significantly higher age， BMI， FPG， TG， TyG index， TC， Hb， BUN， UA， SCr， TC， and LDL-C （all P<0.05）， and the women with diabetes， fatty liver， hypertension， and hyperuricemia were more likely to have gallstones （all P<0.05）. The multivariate logistic regression analysis showed that based on the quartiles of TyG index， the risk of gallstones in the Q3 （8.97‍ ‍—‍ ‍9.38） group was 1.38 （95% confidence interval ［CI］： 1.15‍ ‍—‍ ‍1.62， P<0.001） times that in the Q1 （<8.63） group， and the risk of gallstones in the Q4 （≥9.38） group was 1.39 （95%CI： 1.16‍ ‍—‍ ‍1.68， P<0.001） times that in the Q1 group. After adjustment for all covariates， TyG index， as a continuous variable， showed an independent positive correlation with the risk of gallstones （odds ratio ［OR］=1.24， 95%CI： 1.11‍ ‍—‍ ‍1.39， P=0.004）. The restricted cubic spline curve revealed a significant nonlinear association between TyG index and the risk of gallstones （P for non linear=0.008）， and the threshold analysis showed statistical significance in the effect of TyG index below the inflection point of 8.95 （OR=1.34， 95%CI： 1.15‍ ‍—‍ ‍1.97， P=0.042）. The subgroup analysis showed that TyG index was significantly positively correlated with gallstones in women with a BMI of<25 kg/m²， an age of<50 years， an age of ≥50 years， the absence of diabetes or fatty liver， total cholesterol<5.72 mmol/L， total bilirubin<21 μmol/L， a hemoglobin level of 110‍ ‍—‍ ‍150 g/L， and blood urea nitrogen<7.5 μmol/L （all P<0.05）. A mediating analysis was performed for the subgroups with a statistically significant P value for interaction， and the results showed that BMI accounted for 23.0% of the mediating effect in the influence of TyG index on gallstones， and fatty liver and diabetes accounted for 15.7% and 21.0%， respectively. Conclusion In women， a higher TyG index indicates a higher risk of gallstones. Lowering TyG index may reduce the risk of gallstones by improving insulin sensitivity.
- Triglyceride Glucose Index /
- Gallstones /
- Insulin Resistance /
- Cross-Sectional Studies

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图 1 不同TyG指数分组的女性胆囊结石患病率

Figure 1. The prevalence of gallstones in women across different TyG index groups

下载: 全尺寸图片幻灯片

图 2 TyG指数与女性胆囊结石患病风险的RCS曲线

Figure 2. The restricted cubic spline （RCS） curve of the correlation between the TyG index and the risk of gallstones in women

下载: 全尺寸图片幻灯片

注：除效应修正因子外，所有协变量均按模型3调整亚组分析结果。

图 3 TyG指数与女性胆囊结石风险关联的亚组分析

Figure 3. Subgroup analysis of the association between the TyG index and the risk of gallstones in women

下载: 全尺寸图片幻灯片

表 1 胆囊结石组和非胆囊结石组的一般资料比较

Table 1. Comparison of general data between gallstone and non-gallstone groups

变量	胆囊结石组（n=1 763）	非胆囊结石组（n=21 216）	统计值	P值
年龄（岁）	50.95±14.51	42.80±13.92	t=23.552	<0.001
BMI（kg/m²）	23.79±3.23	22.61±3.06	t=15.439	<0.001
FPG（mmol/L）	5.09（4.76～5.56）	4.90（4.62～5.25）	Z=14.057	<0.001
TG（mmol/L）	1.23（0.87～1.74）	0.98（0.72～1.42）	Z=15.869	<0.001
LDL-C（mmol/L）	2.96±0.78	2.79±0.78	t=9.046	<0.001
TyG	9.27±0.60	9.02±0.58	t=17.569	<0.001
TBil（μmol/L）	10.36±4.90	10.07±4.88	t=2.386	0.017
Hb（g/L）	134.19±11.55	132.61±11.69	t=5.472	<0.001
BUN（mmol/L）	4.96±1.29	4.81±1.23	t=5.019	<0.001
UA（μmol/L）	281.52±65.84	266.51±61.06	t=9.855	<0.001
SCr（μmol/L）	67.85±10.55	66.69±9.73	t=4.795	<0.001
TC（mmol/L）	4.79±0.89	4.59±0.90	t=8.736	<0.001
脂肪肝［例（%）］	564（31.99）	3 567（16.81）	χ²=254.310	<0.001
糖尿病［例（%）］	121（6.86）	562（2.65）	χ²=100.245	<0.001
高尿酸血症［例（%）］	198（11.23）	1 482（6.99）	χ²=43.296	<0.001
高血压［例（%）］	373（21.21）	3 182（15.00）	χ²=48.079	<0.001

下载: 导出CSV

表 2 TyG指数与女性胆囊结石患病的相关性

Table 2. The correlation between the TyG index and the prevalence of gallstones in women

变量	模型1		模型2		模型3
变量	OR（95%CI）	P值	OR（95%CI）	P值	OR（95%CI）	P值
TyG	1.94（1.79～2.09）	<0.001	1.28（1.17～1.40）	<0.001	1.24（1.11～1.39）	0.004
TyG四分位数
Q1组	1.00		1.00		1.00
Q2组	1.32（1.12～1.57）	0.001	1.09（0.91～1.29）	0.352	1.08（0.91～1.29）	0.446
Q3组	2.19（1.87～2.57）	<0.001	1.41（1.19～1.66）	<0.001	1.38（1.15～1.62）	<0.001
Q4组	3.17（2.73～3.70）	<0.001	1.57（1.32～1.86）	<0.001	1.39（1.16～1.68）	<0.001
趋势检验P值	<0.001		<0.001		<0.001

下载: 导出CSV

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