目的 探究血清细胞间黏附分子-1（ICAM-1）、血管细胞黏附分子-1（VCAM-1）与甘油三酯-葡萄糖指数（TyG指数）对老年高血压合并代谢相关脂肪性肝病（MASLD）患者颈动脉病变的诊断价值。 方法 回顾性研究选取2021年6月至2023年7月医院收治的老年高血压合并MASLD患者共189例作为本次研究对象，采用彩色多普勒超声诊断仪检测所有患者颈动脉内膜中层厚度（IMT），并根据IMT检测结果将患者分为IMT正常组（IMT < 1.0 mm）和IMT增厚组（IMT > 1.0 mm），收集并分析两组患者一般资料，采用酶联免疫吸附法检测患者血清ICAM-1、VCAM-1水平，由空腹血糖及甘油三酯计算得到TyG指数，比较两组患者相关指标的差异性。采用多因素logistic回归分析老年高血压合并MASLD患者IMT增厚的危险因素，应用Pearson相关性分析血清ICAM-1、VCAM-1及TyG指数与IMT增厚的相关性，根据受试者工作特征（ROC）曲线下面积评估血清ICAM-1、VCAM-1及TyG指数单一检测以及联合检测对老年高血压合并MASLD患者颈动脉病变的诊断效能。 结果 根据IMT检测结果共有71例患者IMT增厚，占比37.57%，通过对比显示，IMT增厚组患者收缩压、舒张压、甘油三酯、AST、ALT水平均高于IMT正常组（P < 0.05），血清ICAM-1、VCAM-1水平，以及TyG指数均较IMT正常组更高（P < 0.05）；logistic回归分析显示，老年高血压合并MASLD患者收缩压、舒张压、甘油三酯、天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、ICAM-1、VCAM-1水平以及TyG指数、空腹胰岛素（FINS）升高是IMT增厚的主要危险因素；通过Pearson相关性分析得出，血清ICAM-1、VCAM-1以及TyG指数与老年高血压合并MASLD患者IMT增厚均呈正相关（P < 0.05）；ROC曲线结果显示，血清ICAM-1、VCAM-1以及TyG指数联合检测诊断老年高血压合并MASLD患者IMT增厚的AUC高于各指标单独检测（P < 0.05）。 结论 血清ICAM-1、VCAM-1及TyG指数在诊断老年高血压合并MASLD患者IMT增厚方面具有较高的敏感度和特异度，提示其可能作为辅助工具，在该类患者的颈动脉病变风险评估中发挥重要作用。

Objective To assess the diagnostic effectiveness of intercellular adhesion molecule-1 （ICAM-1）， vascular cell adhesion molecule-1 （VCAM-1）， and the triglyceride-glucose index （TyG index） in detecting abnormalities of carotid artery intima-media thickness （IMT） in elderly hypertensive patients with metabolically associated steatotic liver disease （MASLD）. Methods A retrospective analysis was carried out on 189 elderly hypertensive patients with MASLD who were admitted to our institution between June 2021 and July 2023. All the subjects had their carotid IMT measured by color Doppler ultrasound and were classified into two groups： the normal group （IMT < 1.0 mm） and the thickened group （IMT ≥ 1.0 mm） according to the ultrasound results. Clinical data collection involved quantifying serum ICAM-1 and VCAM-1 by enzyme - linked immunosorbent assay （ELISA）， calculating the triglyceride glucose （TyG） index from fasting glucose and triglyceride levels， and conducting a comparative analysis of the differences in relevant parameters between the groups. Multivariate logistic regression was used to identify the independent risk factors for IMT thickening， and Pearson correlation analysis was employed to assess the relationships between serum biomarkers and the IMT status. The diagnostic performance was evaluated through receiver operating characteristic （ROC） curve analysis. Results IMT thickening was detected in 71 patients （37.57%）. In comparison with the normal IMT group， the thickened IMT group showed significantly higher levels of systolic/diastolic blood pressure， triglycerides， aspartate aminotransferase （AST）， alanine aminotransferase （ALT）， serum ICAM - 1， VCAM - 1， and TyG index （all P < 0.05）. Logistic regression analysis confirmed that these parameters were independent risk factors for IMT thickening. The levels of serum ICAM - 1， VCAM - 1， and TyG index were positively correlated with IMT thickening （IMT ≥1.0 mm） （all P < 0.05）. ROC analysis indicated that the combined biomarker assessment had better diagnostic accuracy than individual markers （P < 0.05）. Conclusions Serum ICAM-1， VCAM-1， and the TyG index exhibit high diagnostic sensitivity and specificity for IMT abnormalities in this patient population， which validates their utility as adjunctive tools for carotid artery lesion risk stratification in elderly hypertensive patients with MASLD.