【摘要】 目的 探讨甘油三酯-葡萄糖指数-脂质蓄积指数（TyG-LAP）与中国中老年人群心血管疾病发病风险的关联。方法 选取2011—2020年中国健康与养老追踪调查（CHARLS）数据库中的5 503例中老年人为研究对象，其中新发心血管疾病904例。将研究对象以TyG-LAP四分位数分为四组（Q₁～Q₄）,采用多因素logistic回归探讨TyG-LAP与心血管疾病发病风险的关联。采用限制性立方样条（RCS）进一步分析TyG-LAP与心血管疾病发病风险的剂量-反应关系。采用亚组分析和交互作用检验，考察不同社会人口学及临床特征对关联的潜在影响。此外，采用敏感性分析验证结果的稳健性。结果 新发心血管疾病组与未发生心血管疾病组年龄、性别、高血压、糖尿病、吸烟和饮酒情况及体重指数分布比较，差异均有统计学意义（P<0.05）。校正所有潜在混杂因素后，多因素logistic回归分析结果显示，相比于TyG-LAP的Q₁组，Q₃组和Q₄组的心血管疾病发病风险分别增加41%（OR=1.41,95%CI 1.13～1.77,P=0.003）和46%（OR=1.46,95%CI 1.16～1.84,P=0.001）。RCS分析结果表明，校正所有潜在混杂因素后，TyG-LAP与心血管疾病的发病风险间存在显著正向关联(P_总体=0.001)。亚组分析显示，婚姻状况可能对TyG-LAP与CVD风险的关联具有潜在的调节作用(P_交互=0.019),但在已婚及其他婚姻状况亚组中，该关联均未达到统计学显著性，其他亚组未发现显著交互作用。敏感性分析显示，校正C反应蛋白后，TyG-LAP与心血管疾病风险之间的正向剂量-反应关联依然保持高度显著性，进一步的Cox分析显示，标准化后的TyG-LAP每升高1个标准差，受访者发生心血管疾病的风险增加10%（HR=1.10,95%CI 1.02～1.20,P=0.019）,进一步支持了主分析的结果。结论 在中老年人群中，TyG-LAP的升高与心血管疾病发生风险增加显著相关，应加强对中老年人群的胰岛素抵抗和内脏脂肪的监测和综合干预。更多还原

【Abstract】 Objective This study investigates triglyceride-glucose index-lipid accumulation product（TyG-LAP） as a predictor of incident cardiovascular diseases（CVD） in middle-aged and older Chinese cohorts.Methods A total of 5 503 middle-aged and elderly participants from the China Health and Retirement Longitudinal Study（CHARLS） database from 2011 to 2020 were enrolled, among whom there were 904 newly diagnosed with cardiovascular disease.Participants were divided into four groups（Q₁～Q₄） according to the quartiles of their TyG-LAP.CVD risk associated with TyG-LAP was quantified using multivariable logistic regression.Furthermore, restricted cubic splines（RCS） modeled the dose-response relationship between TyG-LAP and CVD risk.In addition, subgroup analysis and interaction tests were used to examine the potential impact of different demographic and clinical characteristics on this association.Additionally, sensitivity analysis was conducted to verify the robustness of the results.Results Comparisons between those who developed cardiovascular disease and those who did not show statistically significant differences in age, sex, hypertension, diabetes, smoking and drinking status, and body mass index distribution（all P<0.05）.After adjusting for all potential confounding factors, multivariable logistic regression analysis revealed that compared with the TyG-LAP Q₁ group, the risk of cardiovascular disease was increased by 41% in the Q₃ group（OR=1.41,95%CI 1.13～1.77,P=0.003） and by 46% in the Q₄ group（OR=1.46,95%CI 1.16～1.84,P=0.001）.Analysis using RCS revealed a significant positive correlation between the TyG-LAP and the risk of cardio-cerebrovascular disease, even after adjusting for all potential confounding variables(P_overall=0.001).In addition, subgroup analysis and interaction tests were used to examine the potential impact of different demographic and clinical characteristics on this association.Subgroup analysis suggested that marital status may have a modifying effect on the association between TyG-LAP and CVD risk（interaction P=0.019）;however, this association was not statistically significant within either the married or other marital status subgroups. No significant interactions were observed in the other subgroups. Sensitivity analysis showed that after adjusting for C-reactive protein, the positive dose-response relationship between the TyG-LAP and the risk of cardiovascular disease remained highly significant.Further Cox analysis indicated that for each one-standard-deviation increase in the standardized TyG-LAP,the risk of cardiovascular disease increased by 10%（HR=1.10,95%CI 1.02～1.20,P=0.019）,further supporting the main findings.Conclusion In middle-aged and elderly populations, an elevated TyG-LAP is significantly associated with an increased risk of CVD.Monitoring and comprehensive intervention for insulin resistance and visceral fat in middle-aged and elderly individuals should be strengthened.更多还原