【摘要】 目的 探讨甘油三酯葡萄糖指数（TyG）和胰岛素抵抗代谢评分（METS-IR）与心血管代谢性共病（CMM）发生风险的关系，并评估其预测价值，为社区中老年人群CMM早期筛查和防控工作提供科学依据。方法 选取2018年1月至2021年12月广西玉林市五里桥社区的2 588例非CMM中老年人作为研究对象，随访收集健康体检数据，随访期限截至2024年7月21日。使用R 4.2.3和SPSS 27.0软件进行t检验和χ²检验。采用Cox比例风险回归模型分析TyG和METS-IR与新发CMM的关联性，使用Kaplan-Meier方法比较组间累计发病风险，利用限制性立方样条（RCS）探讨剂量反应关系，并通过时间依赖性受试者工作特征（ROC）曲线评估预测效能。结果 随访截至2024年7月21日，共有292例新发CMM，中位随访时间为30.8个月，发病率为4.66例/100人年。多变量Cox回归分析结果表明，TyG（HR=1.846,95%CI:1.543～2.208,P<0.01）、METS-IR（HR=1.083,95%CI:1.053～1.114,P<0.01）与CMM发生风险均呈正相关。三分位分组后，相比最低分位组，TyG和METS-IR的最高分位组发生CMM的风险分别为2.629倍（95%CI:1.908～3.623）和2.571倍（95%CI:1.653～3.999）。RCS分析结果显示，TyG(P_总体<0.01,P_非线性<0.05)和METS-IR(P_总体<0.01,P_非线性<0.01)与CMM风险呈正向非线性关联。时间依赖性ROC分析显示，TyG和METS-IR在12、24和36个月的受试者工作特征曲线下面积（AUC）逐渐升高，均在第36个月时达到最高，分别为0.65和0.64。结论 TyG和METS-IR与中老年人群CMM发生风险呈正向关联，可作为CMM发生风险预测的候选指标。更多还原

【Abstract】 Objective To explore the relationship between the triglyceride glycemic index（TyG） or insulin resistance metabolic score（METS-IR） and the risk of cardiometabolic multimorbidity（CMM）,evaluate their predictive value,and provide the scientific basis for early screening,control and prevention of CMM among the elderly in communities. Methods From January 2018 to December 2021,2 588 middle-aged and elderly residents without CMM from the Wuliqiao community in Yulin city of Guangxi were selected as the subjects. Follow-up data（including health check-up information） were collected until July 21,2024. The used software was R 4.2.3 and SPSS 27.0,the t test and χ² test were used to analyze the data;Cox proportional hazards regression was used to analyze the association of TyG and METS-IR with new CMM,Kaplan-Meier method was used to compare the cumulative incidence risk,the restricted cubic splines（RCS） were used to explore the dose-response relationship,the time-dependent ROC curves were used to evaluate predictive efficiency. Results The end of the follow-up was July 21,2024,292 new cases of CMM were identified. The follow-up duration median was 30.8 months,the incidence rate was 4.66 cases/100 person-years. Multivariable Cox regression analysis revealed that TyG（HR=1.846,95%CI:1.543-2.208,P<0.01） and METS-IR（HR=1.083,95%CI:1.053-1.114,P<0.01） positively correlated to the risk of CMM. When stratified by tertiles,the risks of CMM in the highest TyG group（OR=2.629,95%CI:1.908-3.623,P<0.01） and METS-IR group（OR=2.571,95%CI:1.653-3.999,P<0.01） were higher than the lowest tertile group. RCS analysis showed the positive nonlinear relationship between TyG(P_overall<0.01,P_nonlinear<0.05) or METS-IR(P_overall<0.01,P_nonlinear<0.01) and the risk of CMM. Time-dependent ROC analysis showed that the areas under the receiver operating characteristic curve（AUC） for TyG and METS-IR gradually increased at 12,24 and 36 months,reaching 0.65 and 0.64 respectively at 36 months. Conclusion Both TyG and METS-IR are positively correlated to CMM risk in middle-aged and elderly residents and may serve as useful predictors for its early detection.更多还原