甘油三酯-葡萄糖指数与心房颤动患者发生急性心肌梗死风险的关系

doi:10.16138/j.1673-6087.2025.06.02

摘要/Abstract

摘要：

目的：探索甘油三酯-葡萄糖（triglyceride-glucose, TyG）指数与心房颤动（atrial fibrillation, AF）患者发生急性心肌梗死（acute myocardial infarction, AMI）的关系。方法：纳入首都医科大学附属北京同仁医院和首都医科大学附属北京友谊医院4 277例住院的AF患者，根据是否因AMI入院分为未发生AMI组[AMI(−)，3 725例]和发生AMI组[AMI(+), 552例]。采用Logistic回归评估TyG指数与AMI的关系，并根据基线是否存在糖尿病进行亚组分析。结果：在AF患者中，AMI(+)组的TyG指数显著高于AMI(−)组（8.83±0.73比8.56±0.66, P < 0.001），AMI(+)组患者年龄更大、合并症更多（均P < 0.05）。多因素Logistic回归结果显示，高TyG指数是AF患者发生AMI的独立危险因素[优势比（odds ratio, OR)=1.824, 95%CI 1.540~2.161, P < 0.001]，TyG指数预测AMI的受试者操作特征（receiver operating characteristic, ROC）曲线下面积为0.614（95%CI 0.589~0.640, P < 0.001），截断值为8.79。在AF患者中，无论是否存在糖尿病，TyG指数均与AMI发生风险呈正相关。结论：TyG指数与AF患者发生AMI的风险呈正相关，且不受糖尿病状态的影响。

关键词: 甘油三酯-葡萄糖指数, 心房颤动, 急性心肌梗死

Abstract:

Objective To explore the relationship between triglyceride-glucose (TyG) index and the occurrence of acute myocardial infarction (AMI) in patients with atrial fibrillation (AF). Methods A total of 4 277 hospitalized AF patients from Beijing Tongren Hospital and Beijing Friendship Hospital affiliated to Capital Medical University were enrolled. They were divided into a non-AMI group [AMI(−), 3 725 cases] and an AMI group [AMI(+), 552 cases] based on whether they were admitted for AMI. Logistic regression was used to assess the association between the TyG index and AMI, and subgroup analyses were performed according to the presence of diabetes at baseline. Results Among AF patients, the TyG index was significantly higher in the AMI(+) group than in the AMI(−) group (8.83 ± 0.73 vs. 8.56 ± 0.66, P < 0.001). Additionally, patients in the AMI(+) group were older and had more comorbidities (both P < 0.05). Multivariate Logistic regression showed that high TyG index was an independent risk factor for AMI in AF patients [odds ratio(OR) = 1.824, 95%CI 1.540−2.161, P < 0.001], and the area under the receiver operating characteristic (ROC) curve for the TyG index in predicting AMI was 0.614 (95%CI 0.589−0.640, P < 0.001), with a cut-off value of 8.79. In AF patients, the TyG index was positively associated with the risk of AMI regardless of the presence of diabetes. Conclusions The TyG index is positively associated with the risk of AMI in AF patients, which is not affected by diabetes status.

Key words: Triglyceride-glucose index, Atrial fibrillation, Acute myocardial infarction

中图分类号:

陈梁国, 邓可武, 刘越, 钟鹏, 白英. 甘油三酯-葡萄糖指数与心房颤动患者发生急性心肌梗死风险的关系[J]. 内科理论与实践, 2025, 20(06): 435-439.

CHEN Liangguo, DENG Kewu, LIU Yue, ZHONG Peng, BAI Ying. Relationship between triglyceride-glucose index and risk of acute myocardial infarction in patients with atrial fibrillation[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(06): 435-439.

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参考文献 16

[1]	January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons[J]. Circulation, 2019, 140(2):e125-e151.
[2]	Baman JR, Passman RS. Atrial fibrillation[J]. JAMA, 2021, 325(21):2218. doi: 10.1001/jama.2020.23700
[3]	Fontes JD, Lyass A, Massaro JM, et al. Insulin resistance and atrial fibrillation (from the Framingham Heart study)[J]. Am J Cardiol, 2012, 109(1):87-90. doi: 10.1016/j.amjcard.2011.08.008
[4]	Park GM, Cho YR, Won KB, et al. Triglyceride glucose index is a useful marker for predicting subclinical coronary artery disease in the absence of traditional risk factors[J]. Lipids Health Dis, 2020, 19(1):7. doi: 10.1186/s12944-020-1187-0
[5]	Tao LC, Xu JN, Wang TT, et al. Triglyceride-glucose index as a marker in cardiovascular diseases: landscape and limitations[J]. Cardiovasc Diabetol, 2022, 21(1):68. doi: 10.1186/s12933-022-01511-x
[6]	Choe WS, Choi EK, Han KD, et al. Association of metabolic syndrome and chronic kidney disease with atrial fibrillation: a nationwide population-based study in Korea[J]. Diabetes Res Clin Pract, 2019, 148: 14-22. doi: 10.1016/j.diabres.2018.12.004
[7]	Zheng D, Cao L. Association between myocardial infarction and triglyceride-glucose index: a study based on NHANES database[J]. Glob Heart, 2024, 19(1):23. doi: 10.5334/gh.1303
[8]	Bai Y, Liu XY, Liu Y, et al. Prevalence of recommended anticoagulation by guidelines preadmission and its impact on the incidence of acute myocardial infarction (AMI) and in-hospital outcomes after AMI in atrial fibrillation patients[J]. J Thromb Thrombolysis, 2022, 54(1):91-96. doi: 10.1007/s11239-021-02622-0
[9]	Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[J]. J Thorac Cardiovasc Surg, 2016, 152(5):1243-1275. doi: 10.1016/j.jtcvs.2016.07.044
[10]	Chen S, Mei Q, Guo L, et al. Association between triglyceride-glucose index and atrial fibrillation: a retrospective observational study[J]. Front Endocrinol (Lausanne), 2022, 13: 1047927. doi: 10.3389/fendo.2022.1047927
[11]	Lee Y, Cha SJ, Park JH, et al. Association between insulin resistance and risk of atrial fibrillation in non-diabetics[J]. Eur J Prev Cardiol, 2020, 27(18):1934-1941. doi: 10.1177/2047487320908706
[12]	Harati H, Zanetti D, Rao A, et al. No evidence of a causal association of type 2 diabetes and glucose metabolism with atrial fibrillation[J]. Diabetologia, 2019, 62(5):800-804. doi: 10.1007/s00125-019-4836-y
[13]	Zhang Y, Ding X, Hua B, et al. High triglyceride-glucose index is associated with poor cardiovascular outcomes in nondiabetic patients with ACS with LDL-C below 1.8 mmol/L[J]. J Atheroscler Thromb, 2022, 29(2):268-281. doi: 10.5551/jat.61119
[14]	Wang L, Cong HL, Zhang JX, et al. Triglyceride-glucose index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome[J]. Cardiovasc Diabetol, 2020, 19(1):80. doi: 10.1186/s12933-020-01054-z
[15]	Guo W, Zhao L, Mo F, et al. The prognostic value of the triglyceride glucose index in patients with chronic heart failure and type 2 diabetes: a retrospective cohort study[J]. Diabetes Res Clin Pract, 2021, 177: 108786. doi: 10.1016/j.diabres.2021.108786
[16]	Zhu Y, Liu K, Chen M, et al. Triglyceride-glucose index is associated with in-stent restenosis in patients with acute coronary syndrome after percutaneous coronary intervention with drug-eluting stents[J]. Cardiovasc Diabetol, 2021, 20(1):137. doi: 10.1186/s12933-021-01332-4

项目	AMI(−)组（n=3 725）	AMI(+)组（n=552）	t/χ²	P
年龄(岁)	71.44±12.22	74.48±11.66	−5.489	< 0.001
男性[n (%)]	2 054(55.1)	344(62.3)	10.056	0.002
BMI(kg/m²)	25.42±4.01	25.06±3.94	1.268	0.205
曾经或当前吸烟[n (%)]	979(26.3)	207(37.5)	59.633	< 0.001
合并症[n (%)]
高血压	2 486(66.7)	415(75.2)	15.704	< 0.001
糖尿病	1 138(30.6)	244(44.2)	40.971	< 0.001
心力衰竭	1 408(37.8)	197(35.7)	0.913	0.339
陈旧性心肌梗死	249(6.7)	95(17.2)	72.014	< 0.001
既往PCI或CABG	313(8.4)	81(14.7)	22.607	< 0.001
外周血管疾病	205(5.5)	57(10.3)	19.445	< 0.001
TyG指数	8.56±0.66	8.83±0.73	−8.444	< 0.001
辅助检查
LVEF(%)	61.33±10.37	53.86±12.69	11.144	< 0.001
TC(mmol/L)	4.01±1.79	4.08±1.10	−0.952	0.341
LDL-C(mmol/L)	2.42±0.87	2.42±0.90	0.047	0.963
HDL-C(mmol/L)	1.08±0.37	1.08±0.39	−0.405	0.686
TG(mmol/L)	1.30±1.08	1.35±1.07	−0.967	0.334
血糖(mmol/L)	6.28±2.48	8.44±4.33	−11.44	< 0.001

变量	OR	95%CI	P
TyG指数	1.795	1.578~2.042	< 0.001
年龄	1.022	1.014~1.030	< 0.001
性别（男性）	0.743	0.618~0.893	0.002
BMI	0.977	0.944~1.012	0.205
曾经或当前吸烟	2.305	1.857~2.861	< 0.001
高血压	1.510	1.230~1.853	< 0.001
糖尿病	1.801	1.501~2.160	< 0.001
心力衰竭	0.913	0.758~1.100	0.339
陈旧性心肌梗死	2.902	2.247~3.747	< 0.001
既往PCI或CABG	1.875	1.442~2.438	< 0.001
外周血管疾病	1.977	1.453~2.691	< 0.001

变量	OR	95%CI	P
OR：优势比（odds ratio）。
TyG指数	1.824	1.540~2.161	< 0.001
年龄	1.028	1.017~1.039	< 0.001
性别（男性）	0.803	0.611~1.056	0.117
曾经或当前吸烟	2.226	1.716~2.886	< 0.001
高血压	1.089	0.843~1.406	0.513
糖尿病	1.266	0.994~1.613	0.056
陈旧性心肌梗死	2.272	1.601~3.226	< 0.001
既往PCI或CABG	1.190	0.839~1.688	0.328
外周血管疾病	0.893	0.442~1.803	0.752

变量	B	SE	Wald X²	OR	95%CI	P
糖尿病
TyG指数	0.540	0.189	8.128	1.716	1.184~2.488	0.004
曾经或当前吸烟	0.703	0.327	4.616	2.021	1.064~3.838	0.032
心力衰竭	−0.784	0.314	6.225	0.457	0.247~0.845	0.013
陈旧性心肌梗死	0.967	0.467	4.296	2.631	1.054~6.567	0.038
非糖尿病
TyG指数	0.596	0.185	10.331	1.814	1.262~2.609	0.001
年龄	0.028	0.010	7.200	1.028	1.007~1.049	0.007
性别（男性）	−0.860	0.303	8.058	0.423	0.234~0.766	0.005
曾经或当前吸烟	0.768	0.255	9.065	2.156	1.308~3.556	0.003
陈旧性心肌梗死	1.353	0.355	14.556	3.871	1.931~7.758	< 0.001
既往PCI或CABG	0.935	0.368	6.468	2.548	1.239~5.238	0.011