| 杨凌霄,李静,郁建国,王伟,王琴,徐解东,姜永根,赵根明,吴毅凌,刘星.上海市松江区社区居民甘油三酯葡萄糖指数及其结合肥胖指标与代谢功能障碍相关脂肪性肝病患病的关联研究[J].中华流行病学杂志,2026,47(4):690-699 |
| 上海市松江区社区居民甘油三酯葡萄糖指数及其结合肥胖指标与代谢功能障碍相关脂肪性肝病患病的关联研究 |
| Association of triglyceride glucose index and its combination with obesity indicators with metabolic dysfunction-associated steatotic liver disease in community residents of Songjiang District, Shanghai |
| 收稿日期:2025-07-25 出版日期:2026-04-17 |
| DOI：10.3760/cma.j.cn112338-20250725-00525 |
| 中文关键词: 代谢功能障碍相关脂肪性肝病 甘油三酯葡萄糖指数 肥胖 区分能力 |
| 英文关键词: Metabolic dysfunction-associated steatotic liver disease Triglyceride- glucose index Obesity Discriminatory ability |
| 基金项目:上海市公共卫生研究专项青年项目（2025GKQ05，2025GKQ23）；上海市加强公共卫生体系建设三年行动计划重点学科（GWVI-11.1-23）；国家重点研发计划（2023YFC2506704） |
| 作者 | 单位 | E-mail | | 杨凌霄 | 上海市松江区疾病预防控制中心(上海市松江区卫生健康监督所), 上海 201616 | | | 李静 | 上海市松江区中山街道社区卫生服务中心, 上海 201613 | | | 郁建国 | 上海市松江区中山街道社区卫生服务中心, 上海 201613 | | | 王伟 | 上海市松江区新桥镇社区卫生服务中心, 上海 201612 | | | 王琴 | 上海市松江区佘山镇社区卫生服务中心, 上海 201602 | | | 徐解东 | 上海市松江区泖港镇社区卫生服务中心, 上海 201607 | | | 姜永根 | 上海市松江区疾病预防控制中心(上海市松江区卫生健康监督所), 上海 201616 | | | 赵根明 | 复旦大学公共卫生学院流行病学教研室/公共卫生安全教育部重点实验室, 上海 200032 | | | 吴毅凌 | 上海市松江区疾病预防控制中心(上海市松江区卫生健康监督所), 上海 201616 | aries2119@163.com | | 刘星 | 复旦大学公共卫生学院流行病学教研室/公共卫生安全教育部重点实验室, 上海 200032 | liuxing@fudan.edu.cn |
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| 中文摘要: |
| 目的 探究甘油三酯葡萄糖指数（TyG）及其结合BMI、腰围（WC）、腰高比（WHtR）等肥胖指标与社区人群代谢功能障碍相关脂肪性肝病（MASLD）患病的关联。方法 基于2016-2017年上海郊区自然人群队列与生物样本库松江区基线数据，采用多因素logistic回归模型进行TyG及其结合肥胖指标与MASLD患病的关联性分析，并进行性别、年龄分层分析和交互作用分析。采用限制性立方样条模型分析TyG及其结合肥胖指标与MASLD的非线性关联。采用受试者工作特征曲线（ROC）和DeLong检验评估分析TyG及其结合肥胖指标对社区居民MASLD患病的区分能力。结果 33 478名研究对象中，12 593名（37.6%）符合MASLD诊断。多因素logistic回归分析结果显示，与TyG-BMI、TyG-WC、TyG-WHtR、TyG Q1组相比，Q4组MASLD患病风险增加，OR值（95%CI）分别为45.08（40.20~50.56）、36.78（32.94~41.06）、35.05（31.34~39.20）和5.34（4.89~5.82）。与体重正常组相比，肥胖组MASLD患病风险增加，OR值（95%CI）为14.02（12.85~15.29）；与非中心性肥胖组相比，中心性肥胖组（男性WC>90 cm，女性WC>85 cm或WHtR>0.5）MASLD患病风险增加，OR值（95%CI）分别为4.88（4.62~5.16）（WC）、5.66（5.34~6.01）（WHtR）。RCS分析结果显示，社区人群不同性别、不同年龄组TyG及其结合肥胖指标与MASLD患病风险呈非线性关联（均总体P<0.001，非线性P<0.001）。ROC显示，与单一TyG［曲线下面积（AUC）=0.716］或对应的单一肥胖测量指标（BMI：AUC=0.798，WC：AUC=0.764，WHtR：AUC=0.764）相比，3种TyG结合肥胖指标（TyG-BMI、TyG-WC、TyG-WHtR）展现出更优的区分能力，AUC依次为0.824、0.800、0.799。结论 TyG及其结合肥胖指标均与MASLD患病密切相关，可能具备较好的社区人群MASLD筛查应用价值。 |
| 英文摘要: |
| Objective To investigate the associations of the triglyceride-glucose index (TyG) and its combination with obesity indicators such as BMI, WC, and WHtR with the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in a community-based population. Methods Using baseline data from the Shanghai Suburban Adult Cohort and Biobank in Songjiang District during 2016-2017, multivariable logistic regression models were employed to evaluate the associations of the TyG index and its combination with obesity indicators with MASLD. Stratified analyses by sex and age, as well as interaction analyses, were conducted. Restricted cubic splines (RCS) were applied to explore the nonlinear relationships between these indices and MASLD. Receiver operating characteristic (ROC) curves and DeLong's test were used to evaluate the discriminative ability of these indices for MASLD in community residents. Results Among 33 478 study participants, 12 593 met the diagnostic criteria for MASLD (37.6%). Multivariable logistic regression analyses showed that compared with Q1, the Q4 groups had a significantly increased risk of MASLD, with ORs and 95% CI of 45.08 (40.20-50.56) for TyG-BMI, 36.78 (32.94-41.06) for TyG-WC, 35.05 (31.34-39.20) for TyG-WHtR and 5.34 (4.89-5.82) for TyG. Compared with the normal weight group, the obese group had a significantly increased risk of MASLD, with an OR of 14.02 (95%CI: 12.85-15.29). Compared with the non-central obesity group, the central obesity group (defined as WC >90 cm for men, >85 cm for women, or WHtR >0.5) showed an elevated risk of MASLD, with ORs of 4.88 (95%CI: 4.62-5.16) based on WC and 5.66 (95%CI: 5.34-6.01) based on WHtR, respectively. RCS analysis revealed nonlinear relationships between TyG and its combination with obesity indices and MASLD prevalence across different sex and age groups (overall P<0.001, nonlinearity P<0.001). ROC showed that compared with TyG index alone [area under the curve (AUC)=0.716] or single obesity indices (BMI: AUC=0.798, WC: AUC=0.764, WHtR: AUC=0.764), the three TyG-obesity combined indices (TyG-BMI, TyG-WC, TyG-WHtR) exhibited superior discriminative ability, with AUC values of 0.824 for TyG-BMI, 0.800 for TyG-WC, and 0.799 for TyG-WHtR. Conclusion TyG and its combination with obesity indices are closely associated with MASLD prevalence and may have significant potential for community-based MASLD screening. |
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