论文丨老年2型糖尿病患者死亡风险预测的新型复合指标研究

论文发表

近日，由我院王帆教授（共同通讯作者），公卫学院直博生王祎宁（共同第一作者），以及上海市疾控中心施燕主任（共同通讯作者）、吴菲（共同第一作者）等专家合作完成的论文“Combining triglyceride‑glucose index and novel anthropometric measures to predict mortality risk in patients with T2DM: a prospective cohort study”发表于期刊《BMC Endocrine Disorders》（JCR Q2）。该期刊聚焦内分泌疾病的预防、诊断与治疗，涵盖临床、基础与转化研究及相关新技术进展。本研究成果体现了王帆教授团队在社区慢病管理与预防方面的积极探索。

本研究旨在评估甘油三酯-葡萄糖（TyG）指数联合肥胖指标构建的新型复合指标，对老年2型糖尿病（T2DM）患者全因死亡风险的预测效能，并探讨肾功能障碍的中介作用。基于上海市标准化糖尿病管理系统，研究纳入2020-2024年60岁及以上T2DM患者30.7万例，中位随访时间19个月。结果显示，各复合指标与死亡风险均呈U形关联，整体预测能力优于单一TyG指数；其中TyG-ABSI组合指标的预测效能最佳，风险拐点为0.69。进一步中介分析表明，肾功能下降部分介导了高TyG-ABSI与死亡风险增加之间的关联。本研究为老年糖尿病人群的风险分层与个体化管理提供了实证依据，提示该复合指标在临床实践及公共卫生干预中的潜在应用价值。

作者/Authors

Yining Wang1†, Fei Wu2†, Hongfei Mo1,3, Qinghua Yan2, Hongjie Chu1, Mengyan Wang2, Yang Zhou4, Huiting Yu5, Shuyue Sun1,3, Minna Cheng2, Fan Wang3,6* and Yan Shi2*

1.School of Public Health, Fudan University, Shanghai, China

2.Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China

3.Fudan Development Institute, Fudan University, Shanghai, China

4.School of Philosophy, Fudan University, Shanghai, China

5.Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China

6.Health Communication Institute, Fudan University, Shanghai, China

†Yining Wang and Fei Wu contributed equally as co-first authors.

* Corresponding authors

摘要/Abstract

背景胰岛素抵抗可由甘油三酯-葡萄糖（TyG）指数反映，并被认为与肥胖发生相互作用。尽管近期研究已将TyG与肥胖指标相结合，用于预测心血管疾病及死亡风险，但很少有研究纳入新型人体测量指标，也较少在糖尿病人群中评估这些关联。本研究旨在评估TyG 相关复合指标是否能提高对老年2型糖尿病（T2DM）患者全因死亡的预测能力；此外探究肾功能障碍的潜在中介作用。

方法本研究分析了2020年至2024年上海市标准化糖尿病管理体系中307161名60岁以上的2型糖尿病患者。死亡结局通过链接上海市死亡统计登记系统数据获取，随访截至2024年12月31日。通过Cox比例风险模型和限制性立方样条检验TyG相关复合指标与全因死亡率之间的关联，并在拐点两侧分别建立两段式Cox 回归模型。通过受试者工作特征（ROC）曲线分析比较不同指标的预测能力。采用中介分析评估估算肾小球滤过率（eGFR）的中介效应。

结果在中位随访19个月后，共发生14,536例（4.7%）死亡。五个复合指标与全因死亡率之间均呈U形关系。所有复合指标均优于单一TyG指数，其中TyG-ABSI预后效能最高。与TyG-ABSI第三四分位数（Q3）相比，第一四分位（Q1）的风险比（HR）为1.13（95%置信区间[CI] 1.08–1.19），第五四分位（Q5）为1.12（95% CI 1.06–1.18）。阈值分析进一步确定拐点为0.69，在阈值以上HR为1.08（95% CI 1.05–1.11），以下则为0.85（95% CI 0.81–0.89）。eGFR降低介导了高TyG-ABSI与死亡风险增加之间24.3%的关联。

结论TyG-ABSI在预测老年中国T2DM患者全因死亡方面表现出优越的预后准确性，呈U型模式。这些发现强调了保持最佳TyG和内脏肥胖水平的重要性，并支持将TyG-ABSI融入个性化风险管理和公共卫生策略。TyG-ABSI 在预测中国老年T2DM患者全因死亡方面表现出更高的预后准确性，且呈U形关联。上述发现强调维持适宜的 TyG与内脏肥胖水平的重要性，并支持将 TyG-ABSI 纳入个体化风险管理与公共卫生策略。

BackgroundInsulin resistance, indicated by triglyceride-glucose (TyG) index, is thought to interact with obesity. Although recent studies have combined TyG with obesity measures to predict cardiovascular disease and mortality, few studies have incorporated novel anthropometric indicators, nor assessed these associations in diabetic populations. This study aims to assess whether TyG-related composite indices improve the prediction of all-cause mortality among elderly patients with type 2 diabetes mellitus (T2DM). Additionally, it seeks to explore the potential mediating role of renal dysfunction.

MethodsWe analyzed 307,161 individuals with T2DM aged over 60 years enrolled in the Shanghai Standardized Diabetes Management System from 2020 to 2024. Mortality outcomes were obtained by linking to the Shanghai Vital Statistics Registry up to 31 December, 2024. The association between TyG-related composite indices and all-cause mortality was examined using Cox proportional hazards models and restricted cubic splines. Two-piecewise Cox regressions were further developed for each side of the inflection point. Receiver operating characteristic curve analysis compared the predictive capacities of various indices. Mediation analysis was conducted to investigate the mediating effects of estimated glomerular filtration rate (eGFR).

ResultsAfter a median follow-up period of 19 months, 14,536 (4.7%) deaths occurred. A U-shaped relationship was observed between five composite biomarkers and all-cause mortality. All composite indices outperformed the standalone TyG index, with TyG-a body shape index (TyG-ABSI) showing the highest prognostic efficacy. Notably, compared to the third quartile (Q3) of TyG-ABSI, hazard ratios (HRs) were 1.13 (95% confidence interval [CI] 1.08–1.19) for the first quartile (Q1) and 1.12 (95% CI 1.06–1.18) for the fifth quartile (Q5). Threshold analysis further identified an inflection point at 0.69, with HRs of 1.08 (95% CI 1.05–1.11) above and 0.85 (95% CI 0.81–0.89) below the threshold. Decreased eGFR mediated 24.3% of the association between the higher TyG-ABSI and increased mortality.

ConclusionsTyG-ABSI exhibited superior prognostic accuracy for predicting all-cause mortality in elderly Chinese T2DM patients, following a U-shaped pattern. These findings underscore the importance of maintaining optimal TyG and visceral obesity levels and support the integration of TyG-ABSI into personalized risk management and public health strategies.

关键词/Key Words

triglyceride‑glucose index; insulin resistance; obesity; all-cause mortality; type 2 diabetes mellitus

全文链接/Link

来源｜BMC Endocrine Disorders