收稿日期: 2026-02-26
网络出版日期: 2026-06-30
基金资助
广东省颐养健康慈善基金会项目(JZ2024086)
Integrating observational and Mendelian randomization analyses to investigate the association between the triglyceride-glucose index and coronary heart disease
Received date: 2026-02-26
Online published: 2026-06-30
目的 探讨甘油三酯-葡萄糖（triglyceride-glucose index， TyG）指数与冠心病（coronary heart disease， CHD）的关系。 方法 收集2019年1月至2025年2月于广东省茂名市中医院心内科因胸闷痛拟诊CHD并行冠状动脉造影检查的患者临床资料，根据造影结果分为CHD组与非CHD组。以TyG指数水平的四分位数将研究对象分为Q1、Q2、Q3和Q4组，采用多因素logistic回归模型与限制性立方样条模型评估临床TyG水平与CHD患病风险的相关性及趋势。在校正多元协变量后，对TyG指数进行平滑曲线分析，以评估CHD的风险。同时，基于大规模全基因组关联研究汇总数据，采用双样本孟德尔随机化（MR）分析，以前瞻性视角探究TyG指数对CHD的因果效应，以逆方差加权法为主要分析方法，并辅以多种敏感性分析验证因果关系的稳健性。 结果 临床数据分析发现CHD组参与者的年龄、空腹血糖值、甘油三酯、TyG指数、肌酐、AST、患糖尿病、服用降压药及服用降糖药的比例显著高于非CHD组，而高密度脂蛋白低于非CHD组（P < 0.05）。在调整了传统心血管危险因素后，相较于Q1组，Q4组的患者罹患CHD的风险显著增加（OR = 3.41，95%CI = 1.41 ~ 8.26， P = 0.006 6）；趋势分析进一步提示TyG指数与CHD风险存在正向剂量-反应关系。MR分析显示，较高的TyG指数与CHD风险有因果关系（OR = 2.00， 95%CI： 1.64 ~ 2.45， P < 0.001）。 结论 本研究通过临床数据分析和MR证实，较高的TyG指数与CHD风险增加存在正相关及因果关联。该结果揭示TyG指数可以作为识别CHD风险较高个体的生物标志物。
余英滔 , 苏金燕 , 朱秀龙 . 联合观察性研究与孟德尔随机化分析验证甘油三酯-葡萄糖指数与冠心病的关联[J]. 实用医学杂志, 2026 , 42(12) : 2230 -2237 . DOI: 10.3969/j.issn.1006-5725.2026.12.019
Objective To investigate the relationship between the triglyceride-glucose index （TyG index） and coronary heart disease （CHD）. Methods Clinical data were collected from patients who were admitted to the Department of Cardiology of our hospital because of chest tightness and pain with suspected CHD and underwent coronary angiography between January 2019 and February 2025. Based on the angiography results， the participants were classified into a CHD group and a non-CHD group. According to the quartiles of the TyG index， the participants were further divided into Q1， Q2， Q3， and Q4 groups. Multivariate logistic regression and restricted cubic spline models were used to evaluate the correlation and trend between the clinical TyG levels and the risk of CHD. After adjusting for multiple covariates， smooth curve analysis was carried out to assess the risk of CHD. Meanwhile， based on the summary data from large-scale genome-wide association studies， a two-sample Mendelian randomization （MR） analysis was conducted to prospectively explore the causal effect of the TyG index on CHD. The inverse variance weighting method was used as the primary analytical approach， and multiple sensitivity analyses were conducted to verify the robustness of the causal relationship. Results Clinical data analysis revealed that participants in the CHD group had age， fasting blood glucose levels， triglycerides， TyG index， creatinine AST， patients with diabetes， taking antihypertensive drugs and hypoglycemic drugs were significantly higher than those in the non CHD group， while high-density lipoprotein was lower than that in the non CHD group （P < 0.05）. After adjusting for traditional cardiovascular risk factors， patients in the Q1 and Q4 groups of the TyG index had a significantly increased risk of developing CHD （OR=3.41， 95%CI = 1.41 - 8.26， P = 0.006 6）. Trend analysis further revealed a positive dose-response relationship between the TyG index and the risk of CHD. MR analysis demonstrated a causal association between a higher TyG index and an increased risk of CHD （OR = 2.00， 95%CI： 1.64 - 2.45， P < 0.001）. Conclusions This study confirms， via both clinical data analysis and MR， that a higher TyG index is positively and causally associated with an elevated risk of CHD. These findings imply that the TyG index could act as a biomarker for identifying individuals at a greater risk of CHD.
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