文章摘要
TyG、 AIP与残余胆固醇对2型糖尿病患者颈动脉粥样硬化严重程度的预测价值比较
Comparison of the predictive value of triglyceride-glucose index, atherogenic index of plasma, and remnant cholesterol for the severity of carotid atherosclerosis in patients with type 2 diabetes mellitus
投稿时间：2026-04-07  修订日期：2026-08-15
DOI：
中文关键词: 甘油三酯-葡萄糖指数  血浆致动脉粥样硬化指数  残余胆固醇  2型糖尿病  颈动脉粥样硬化  预测价值
英文关键词: Triglyceride-glucose index  Atherogenic index of plasma  Remnant cholesterol  Type 2 diabetes mellitus  Carotid atherosclerosis  Predictive value
基金项目:安徽省教育厅科学研究项目（2025AHGXZK31427）
作者单位邮编
陈婧 安徽医科大学第一附属医院内分泌与代谢病科, 安徽省公共卫生临床中心 230012
雷远* 安徽医科大学第一附属医院内分泌与代谢病科, 安徽省公共卫生临床中心 230012
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中文摘要:
      目的 对比分析甘油三酯-葡萄糖指数（TyG）、血浆致动脉粥样硬化指数（AIP）及残余胆固醇（RC）对2型糖尿病（T2DM）患者颈动脉粥样硬化严重程度的预测价值，筛选最优评估指标，为T2DM颈动脉粥样硬化早期风险分层与个体化防控提供临床依据。方法 回顾性分析2023年1月至2025年4月安徽医科大学第一附属医院北区收治的549例T2DM患者的临床资料，根据颈动脉病变严重程度分为正常组（n=180）、内膜增厚组（n=95）、斑块组（n=240）及狭窄组（n=34），比较四组TyG、AIP、RC水平差异，通过有序多分类Logistic回归、LASSO 回归及合并分组敏感性分析对比三项指标对颈动脉粥样硬化严重程度的独立预测价值；对优势指标开展序贯受试者工作特征（ROC）曲线分析、限制性立方样条（RCS）分析及亚组交互分析。结果 单因素分析结果显示，TyG、AIP、RC水平随颈动脉病变严重程度加重逐渐升高，组间差异具有统计学意义（均P<0.05）。单指标有序多分类Logistic回归分析结果显示TyG、AIP、RC均为T2DM患者颈动脉病变进展的危险因素（均P<0.05）。三项指标联合回归、LASSO回归及合并分组敏感性分析一致显示仅TyG是颈动脉病变进展的独立预测因素（OR分别为1.616、1.849、1.699，均P<0.05），而AIP、RC无独立预测价值（均P>0.05）。基于TyG联合传统危险因素构建的预测模型在病变各阶段均具备良好的预测效能（AUC均>0.80）。RCS分析表明TyG与颈动脉病变风险呈线性关联（非线性P=0.247）。亚组分析显示，TyG预测效应在年龄<60岁、病程≥5年、糖化血红蛋白（HbA1c）<7%、男性、有高血压病史及未使用他汀类药物的T2DM患者中更显著，且与年龄存在交互作用（P=0.015）。 结论 TyG对T2DM患者颈动脉粥样硬化严重程度具有独立预测作用，预测稳定性优于AIP和RC，可为临床早期风险筛查、精准分层及个体化干预提供参考依据。
英文摘要:
      [Abstract] Objective To compare and analyze the predictive value of triglyceride-glucose index (TyG), atherogenic index of plasma (AIP), and remnant cholesterol (RC) for the severity of carotid atherosclerosis in patients with type 2 diabetes mellitus (T2DM), and to identify the optimal assessment indicator, providing clinical evidence for early risk stratification and individualized prevention of T2DM carotid atherosclerosis. Methods Clinical data of 549 T2DM patients admitted to the North District of the First Affiliated Hospital of Anhui Medical University from January 2023 to April 2025 were retrospectively analyzed. Patients were divided into four groups according to the severity of carotid artery lesions: normal group (n=180), intimal thickening group (n=95), plaque group (n=240), and stenosis group (n=34). Differences in TyG, AIP, and RC levels among the four groups were compared. Ordinal multinomial logistic regression, LASSO regression, and combined-group sensitivity analysis were used to compare the independent predictive value of the three indicators for the severity of carotid atherosclerosis. Sequential receiver operating characteristic (ROC) curve analysis, restricted cubic spline (RCS) analysis, and subgroup interaction analysis were performed for the dominant indicator. Results Univariate analysis showed that TyG, AIP, and RC levels gradually increased with the severity of carotid artery lesions, with statistically significant differences among groups (all P<0.05). Univariate ordinal multinomial logistic regression analysis revealed that TyG, AIP, and RC were all risk factors for carotid lesion progression in T2DM patients (all P<0.05). Combined regression, LASSO regression, and combined-group sensitivity analysis consistently demonstrated that only TyG was an independent predictor of carotid lesion progression (OR=1.616, 1.849, and 1.699, respectively, all P<0.05), while AIP and RC showed no independent predictive value (all P>0.05). The predictive model combining TyG with traditional risk factors demonstrated good predictive performance at all stages of lesions (all AUC > 0.80). RCS analysis indicated a linear association between TyG and the risk of carotid artery lesions (nonlinear P=0.247). Subgroup analysis revealed that the predictive effect of TyG was more pronounced in T2DM patients aged <60 years, with disease duration ≥5 years, HbA1c <7%, male, with a history of hypertension, and non-statin users, with a significant interaction with age (P=0.015). Conclusion TyG has an independent predictive effect on the severity of carotid atherosclerosis in T2DM patients, with superior predictive stability compared to AIP and RC, and may provide a reference for early clinical risk screening, precise stratification, and individualized intervention.
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