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甘油三酯葡萄糖体质量指数（TyG-BMI）对高脂血症性急性胰腺炎严重程度的预测价值
DOI: 10.12449/JCH240824
伦理学声明：本研究方案于2023年7月7日经由武汉科技大学附属天佑医院伦理委员会审批，批号：LL-2023-07-07-02。
利益冲突声明：本文不存在任何利益冲突。
作者贡献声明：罗萍萍负责收集数据，资料分析，撰写论文；黄丽雯负责指导文章撰写；刘群负责课题设计，指导论文修改和最后定稿。
Value of triglyceride glucose-body mass index in evaluating the severity of hyperlipidemic acute pancreatitis
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摘要:
目的 探讨甘油三酯葡萄糖体质量指数（TyG-BMI）对高脂血症性急性胰腺炎（HLAP）严重程度的预测价值。 方法 回顾性分析武汉科技大学附属天佑医院2021年1月—2023年12月收治入院的185例HLAP患者临床资料。根据修订的亚特兰大急性胰腺炎分级标准分为轻症组95例和中重症组90例，比较两组患者的临床特征，分析TyG-BMI与HLAP严重程度的相关性，评估TyG-BMI对于HLAP严重程度的预测效能。计量资料两组间比较采用成组t检验或Mann-Whitney U检验。计数资料两组间比较采用χ2检验。单因素和多因素Logistic回归分析HLAP严重程度的影响因素。应用Spearman相关性分析探讨TyG-BMI与HLAP严重程度的关系。采用受试者工作特征曲线配对比较法对TyG-BMI预测HLAP严重程度的效能进行评估。 结果 轻症组和中重症组患者Cr、GLU、TG、TyG-BMI、BISAP评分比较，差异均有统计学意义（Z值分别为-2.059、-7.217、-7.799、-9.566、-11.386，P值均<0.05）。多因素Logistic回归分析结果显示，BISAP评分（OR=4.221，95%CI：1.421～12.538，P=0.001）、TyG-BMI（OR=1.262，95%CI：1.140～1.396，P=0.010）和GLU（OR=1.316，95%CI：1.040～1.666，P=0.022）是HLAP严重程度的独立危险因素，且均与HLAP的严重程度呈正相关（r值分别为0.839、0.705、0.532，P值均<0.05）。在预测HLAP严重程度的效能比较中，TyG-BMI略低于BISAP评分（Z=-4.368，P<0.001），但优于GLU（Z=2.155，P<0.001），其受试者工作特征曲线下面积为0.891，敏感度为91.10%，特异度为96.80%。 结论 TyG-BMI对HLAP严重程度具有一定的预测价值，临床上可用于HLAP病情的综合评估。 -
关键词:
- 胰腺炎 /
- 高脂血症 /
- 甘油三酯葡萄糖体质量指数
Abstract:Objective To investigate the value of triglyceride glucose-body mass index （TyG-BMI） index in predicting the severity of hyperlipidemic acute pancreatitis （HLAP）. Methods A retrospective analysis was performed for the clinical data of 185 patients with HLAP who were admitted to Tianyou Hospital Affiliated to Wuhan University of Science and Technology from January 2021 to December 2023， and according to the revised Atlanta classification criteria for acute pancreatitis， they were divided into mild group with 95 patients and moderate or severe group with 90 patients. Clinical features were compared between the two groups to analyze the correlation between TyG-BMI and the severity of HLAP， and the efficacy of TyG-BMI in predicting the severity of HLAP was analyzed. The independent-samples 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. Univariate and multivariate Logistic regression analyses were used to investigate the influencing factors for the severity of HLAP. A Spearman correlation analysis was used to investigate the correlation between TyG-BMI and the severity of HLAP， and the receiver operating characteristic （ROC） curve was used to analyze the efficacy of TyG-BMI in predicting the severity of HLAP. Results There were significant differences between the mild group and the moderate or severe group in creatinine， blood glucose （GLU）， triglyceride， TyG-BMI， and Bedside Index for Severity in Acute Pancreatitis （BISAP） score （Z=-2.059，-7.217，-7.799，-9.566 and-11.386，all P<0.05）. The multivariate Logistic regression analysis showed that BISAP score （odds ratio ［OR］=4.221， 95% confidence interval ［CI］： 1.421 — 12.538， P=0.001）， TyG-BMI （OR=1.262， 95%CI： 1.140 — 1.396， P=0.010）， and GLU （OR=1.316， 95%CI： 1.040 — 1.666， P=0.022） were independent risk factors for the severity of HLAP and were positively correlated with the severity of HLAP （r=0.839， 0.705， and 0.532， all P<0.05）. In the comparison of the efficacy of these indicators in predicting the severity of HLAP， TyG-BMI had a slightly lower efficacy than BISAP score （Z=-4.368， P<0.001） and a significantly better efficacy than GLU （Z=2.155， P<0.001）， with an area under the ROC curve of 0.891， a sensitivity of 91.10%， and a specificity of 96.80%. Conclusion TyG-BMI index has a certain value in predicting the severity of HLAP and can be used in clinical comprehensive assessment of HLAP. -
Key words:
- Pancreatitis /
- Hyperlipidemias /
- Triglyceride Glucose-Body Mass Index
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表 1 轻症组与中重症组一般资料比较
Table 1. Comparison of general clinical data between mild group and moderate severe group
项目 轻症组（n=95） 中重症组（n=90） 统计值 P值 男性［例（%）］ 68（71.6） 66（73.3） χ2=0.071 0.790 年龄（岁） 41（35～51） 38（33～48） Z=-1.345 0.178 BMI（kg/m2） 25.30±2.83 28.95±3.38 t=-7.976 0.073 吸烟史［例（%）］ 33（34.7） 34（37.8） χ2=0.185 0.667 饮酒史［例（%）］ 32（33.7） 30（33.3） χ2=0.003 0.960 高血压病史［例（%）］ 19（20.0） 22（24.4） χ2=0.529 0.467 糖尿病史［例（%）］ 11（11.6） 16（17.8） χ2=1.425 0.233 高脂血症病史［例（%）］ 25（26.3） 31（34.4） χ2=1.447 0.229 脂肪肝病史［例（%）］ 8（8.4） 9（10.0） χ2=0.138 0.710 
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表 2 轻症组与中重症组实验室指标比较
Table 2. Comparison of group laboratory indicators between mild group and moderate severe group
项目 轻症组（n=95） 中重症组（n=90） Z值 P值 NLR 6.63（4.41～10.23） 7.46（4.90～12.36） -1.361 0.173 PLR 145.61（103.53～211.11） 172.18（115.50～264.78） -1.703 0.089 AST（U/L） 23.00（19.00～32.00） 26.00（18.00～35.00） -1.163 0.245 ALT（U/L） 23.00（15.00～36.00） 27.50（19.75～38.00） -1.760 0.078 TBil（μmol/L） 13.95（10.31～18.90） 15.37（11.14～19.99） -0.581 0.561 Cr（μmol/L） 65.20（51.13～73.55） 69.60（58.80～79.70） -2.059 0.040 GLU（mmol/L） 8.50（6.50～11.20） 13.41（10.75～17.23） -7.217 <0.001 TG（mmol/L） 11.38（9.13～14.82） 18.13（15.41～22.56） -7.799 <0.001 TC（mmol/L） 7.40（6.10～8.69） 7.81（6.05～9.12） -0.460 0.645 HDL-C（mmol/L） 0.92（0.71～1.14） 0.88（0.71～1.24） -0.580 0.562 LDL-C（mmol/L） 1.56（1.17～2.23） 1.47（0.93～2.13） -1.591 0.112 TyG-BMI 98.06（91.51～104.34） 137.80（131.73～142.64） -9.566 <0.001 BISAP评分 1（0～1） 2（2～3） -11.386 <0.001
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表 3 单因素和多因素Logistic回归分析结果
Table 3. Univariate and multivariate Logistic regression analysis results
因素 单因素分析 多因素分析 OR（95%CI） P值 OR（95%CI） P值 BMI 1.481（1.302～1.686） <0.001 1.080（0.927～1.259） 0.322 GLU 1.328（1.213～1.454） <0.001 1.316（1.040～1.666） 0.022 TG 1.285（1.190～1.388） <0.001 1.051（0.917～1.206） 0.473 TyG-BMI 1.255（1.165～1.352） <0.001 1.262（1.140～1.396） 0.010 BISAP评分 10.510（5.574～19.817） <0.001 4.221（1.421～12.538） 0.001
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表 4 不同指标预测HLAP严重程度的ROC曲线分析
Table 4. ROC analysis of HLAP severity predicted by different indexes
变量 AUC cut-off值 敏感度 特异度 约登指数 95%CI P值 BISAP评分 0.985 1.500 1.000 0.966 0.966 0.972～0.998 <0.001 TyG-BMI 0.891 119.196 0.911 0.968 0.879 0.845～0.937 <0.001 GLU 0.807 9.740 0.822 0.674 0.496 0.745～0.869 <0.001
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