目的 探讨胰岛素抵抗（insulin resistance，IR）新型评价指标与2型糖尿病（type 2 diabetes mellitus，T2DM）患者下肢动脉病变（lower extremity arterial disease，LEAD）的预测效能。 方法 选取2022年1月至2025年4月于菏泽市牡丹人民医院内分泌代谢科住院治疗的T2DM患者1 164例，根据是否患有LEAD分为非LEAD组（n = 694）和LEAD组（n = 470），收集两组一般资料、生化指标，计算三酰甘油葡萄糖指数（TyG）、三酰甘油葡萄糖-体质量指数（TyG-BMI）、估计葡萄糖处置率（eGDR）、三酰甘油/高密度脂蛋白胆固醇指数（TG/HDL-C）、胰岛素抵抗代谢评分指数（METS-IR）。logistic回归分析T2DM患者发生LEAD的影响因素，以及不同四分位数分组的IR新型评价指标与LEAD发病风险的相关性。受试者工作特征曲线（ROC）分析IR新型评价指标对T2DM患者发生LEAD的预测价值。 结果 LEAD组TyG、TyG-BMI、TG/HDL、METS-IR显著高于非LEAD组，eGDR低于非LEAD组（P < 0.05）。logistic回归分析显示，TyG、TyG-BMI、METS-IR是T2DM患者发生LEAD的危险因素，eGDR是其保护因素。调整混杂因素后，与Q1组相比，TyG（OR = 3.647，95%CI：1.082 ~ 7.972，P < 0.001）、TyG-BMI（OR = 3.027，95%CI： 1.275 ~ 9.753，P < 0.001）、METS-IR（OR = 4.032，95%CI：1.242 ~ 12.385，P < 0.001）的Q4组发生LEAD的风险显著增加。Q4组eGDR的LEAD发病风险显著下降（OR = 0.225，95%CI： 0.118 ~ 0.429，P < 0.001）。ROC曲线分析显示，METS-IR、TyG、TyG-BMI、eGDR对LEAD均具有预测价值，曲线下面积分别为0.823、0.758、0.773、0.737。亚组分析显示，在年龄≥ 60岁、病程≥ 5年、HbA_1C ≥ 7.0%、有吸烟史、高血压亚组中，METS-IR与LEAD的相关性更显著。 结论 TyG、TyG-BMI、METS-IR水平升高、eGDR水平下降与T2DM患者LEAD发病风险增加存在相关性，METS-IR对T2DM患者发生LEAD具有较高预测效能，有望作为其筛查及风险评估工具。

Objective To investigate the association between novel evaluation indicators of IR and LEAD in patients with T2DM. Methods A total of 1，164 T2DM patients hospitalized in the Department of Endocrinology and Metabolism of Heze Mudan People's Hospital from January 2022 to April 2025 were enrolled. They were divided into the non-LEAD group （694 cases） and the LEAD group （470 cases） according to the presence of LEAD. General data and biochemical indicators were collected， and the triglyceride-glucose index （TyG）， triglyceride-glucose-body mass index （TyG-BMI）， estimated glucose disposal rate （eGDR）， triglyceride-to-high-density lipoprotein cholesterol ratio （TG/HDL-C）， and Metabolic Syndrome Insulin Resistance index （METS-IR） were calculated. Logistic regression analysis was performed to analyze the influencing factors for the development of LEAD in T2DM patients， as well as the correlation between novel IR assessment indices grouped by different quartiles and the risk of LEAD onset. Receiver operating characteristic （ROC） curve analysis was performed to evaluate the predictive value of these indicators for LEAD. Results Compared with non-LEAD group， the LEAD group had significantly higher TyG， TyG-BMI， TG/HDL-C， and METS-IR， but lower eGDR （all P < 0.05）. Logistic regression analysis showed that TyG， TyG-BMI， and METS-IR were identified as risk factors for the development of LEAD in patients with T2DM， while eGDR was a protective factor against it. After adjusting for confounders， compared with the Q1 group， the Q4 groups of TyG （OR = 3.647， 95%CI： 1.082 ~ 7.972， P < 0.001）， TyG-BMI （OR = 3.027， 95%CI： 1.275 ~ 9.753， P < 0.001）， and METS-IR （OR = 4.032， 95%CI： 1.242 ~ 12.385， P < 0.001） had a significantly increased LEAD risk， while the Q4 group of eGDR had a significantly decreased risk （OR = 0.225， 95%CI： 0.118 ~ 0.429， P < 0.001）. ROC curve analysis showed that METS-IR， TyG， TyG-BMI， and eGDR all exhibit predictive value for LEAD， with areas under the curve being 0.823， 0.758， 0.773， and 0.737， respectively. Subgroup analysis indicated that METS-IR was more strongly correlated with LEAD in subgroups of age ≥ 60 years， disease duration ≥ 5 years， HbA?C ≥ 7.0%， smoking history， and hypertension. Conclusion Elevated levels of TyG， TyG-BMI， and METS-IR， along with decreased levels of eGDR， are associated with an increased risk of LEAD onset in patients with T2DM. METS-IR exhibits high predictive efficacy for the development of LEAD in T2DM patients and may serve as a tool for its screening and risk assessment.