2026 年第 7 期 第 21 卷

甘油三酯-葡萄糖体重指数与中老年高血压患者不良心血管事件风险的关联研究

Association between triglyceride-glucose body mass index and the risk of adverse cardiovascular events in middle-aged and elderly hypertensive patients

作者：任璐江娴韵杨晶仪

英文作者：Ren Lu Jiang Xianyun Yang Jingyi

单位：首都医科大学附属北京安贞医院北京市心肺血管疾病研究所心血管基础与临床转化医学中心，北京101118

英文单位：Cardiovascular Basic and Clinical Translational Medicine Center Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 101118 China

关键词：高血压病；甘油三酯-葡萄糖体重指数；中国健康与养老追踪调查

英文关键词：Hypertension;Triglyceride-glucosebodymassindex;Chinahealthandretirementlongitudinalstudy

• 摘要：

• 目的 探讨甘油三酯-葡萄糖体重指数（TyG-BMI）与中老年高血压患者不良心血管事件风险的关联。方法 纳入中国健康与养老追踪调查数据库2011年共2 981例≥45岁的中老年高血压患者，其中至2015年随访期间新发不良心血管事件者233例（有心血管事件组），未发生不良心血管事件者2 748例（无心血管事件组）。运用Cox比例风险模型分析TyG-BMI连续变量及TyG-BMI分组［以研究人群中TyG-BMI的中位数（212.1）为截点，将人群分为低值组（102.4～212.1）和高值组（>212.1～432.1）］与不良心血管事件发生风险的关系。绘制限制性立方样条分析TyG-BMI与中老年高血压患者不良心血管事件发生风险的剂量-反应关系。根据年龄(<60岁与≥60岁)、性别、糖尿病史、吸烟史及饮酒史情况进行亚组分析。结果 有心血管事件组体重指数、低密度脂蛋白胆固醇、血尿酸、C反应蛋白、糖化血红蛋白及TyG-BMI水平均高于无心血管事件组（均P<0.05）。此外，有心血管事件组高脂血症、糖尿病及肾脏疾病的患病比例显著高于无心血管事件组，而高密度脂蛋白胆固醇水平、收缩压测量值则低于无心血管事件组（均P<0.05）。在总人群中，将TyG-BMI作为连续变量纳入Cox比例风险回归分析时，其在各模型中均与不良心血管事件风险呈正向关联。在最充分校正的模型3中，以TyG-BMI中位数分组，高值组相对于低值组，发生不良心血管事件的风险增加了36%（风险比=1.36，95%置信区间：1.05～1.76，P=0.020）。在所有亚组中，TyG-BMI（第2四分位数相较于第1四分位数）的风险估计方向均与总人群一致（即较高TyG-BMI对应风险升高），各亚组内均未见显著异质性（年龄、糖尿病史、饮酒状态、性别及吸烟史分层具体交互作用检验P值分别为：0.157、0.518、0.679、0.803、0.807），TyG-BMI升高所提示的不良心血管事件风险均保持相对稳定。结论 TyG-BMI增加是中老年高血压患者发生不良心血管事件风险的危险因素。该指标计算简便、经济高效，可作为评估高血压患者心脏病风险的潜在简易工具。

• Objective To explore the association between triglyceride-glucose body mass index (TyG-BMI) and the risk of adverse cardiovascular events in middle-aged and elderly hypertensive patients. Methods  A total of 2 981 middle-aged and elderly hypertensive patients aged ≥45 years from the 2011 wave of the China health and retirement longitudinal study database were enrolled. During follow-up until 2015, 233 patients developed new-onset adverse cardiovascular events (cardiovascular event group), and 2 748 patients remained free of adverse cardiovascular events (non-cardiovascular event group). Cox proportional hazards models were used to analyze the relationship of continuous TyG-BMI and categorized TyG-BMI ［stratified by the median TyG-BMI of the study population (212.1) as the cut-off value; participants were divided into low-value group (102.4-212.1) and high-value group (>212.1-432.1)］ with the risk of adverse cardiovascular events. Restricted cubic splines were plotted to analyze the dose-response relationship between TyG-BMI and the risk of adverse cardiovascular events in middle-aged and elderly hypertensive patients. Subgroup analyses were performed stratified by age (<60 years vs ≥60 years), gender, diabetes history, smoking history and drinking history. Results The levels of body mass index, low-density lipoprotein cholesterol, serum uric acid, C-reactive protein, glycated hemoglobin and TyG-BMI in the cardiovascular event group were higher than those in the non-cardiovascular event group (all P<0.05). In addition, the prevalence rates of hyperlipidemia, diabetes mellitus and renal diseases were significantly higher, while high-density lipoprotein cholesterol and systolic blood pressure levels were lower in the cardiovascular event group compared with the non-cardiovascular event group (all P<0.05). When TyG-BMI was included as a continuous variable in Cox proportional hazards regression analysis for the overall population, it was positively associated with the risk of adverse cardiovascular events across all models. In the fully adjusted Model 3 stratified by the median TyG-BMI, the high-value group had a 36% increased risk of adverse cardiovascular events relative to the low-value group (hazard ratio=1.36, 95% confidence interval: 1.05-1.76, P=0.020). The risk estimates of TyG-BMI (the second quartile versus the first quartile) were consistent with those of the overall population across all subgroups (i.e., higher TyG-BMI corresponded to elevated risk), with no significant heterogeneity observed within each subgroup (the P values for interaction tests stratified by age, diabetes history, drinking status, gender and smoking history were 0.157, 0.518, 0.679, 0.803 and 0.807, respectively). The elevated risk of adverse cardiovascular events indicated by increased TyG-BMI remained relatively stable across subgroups. Conclusions Elevated TyG-BMI is a risk factor for adverse cardiovascular events in middle-aged and elderly hypertensive patients. This indicator is easy to calculate and cost-effective, and can serve as a potential simple tool for evaluating cardiac risk in hypertensive patients.