首都医科大学学报 ›› 2026, Vol. 47 ›› Issue (2): 316-325.doi: 10.3969/j.issn.1006-7795.2026.02.013

• 脑血管病的基础与临床研究 • 上一篇    下一篇

三酰甘油-高密度脂蛋白胆固醇-葡萄糖体指数与中国中老年人群卒中发病风险的关系

王伟胜1，2 , 王婷3,宋时雨1,付波4,赵咏梅5*#,李森2，6*#   

  1. 1.山东第二医科大学临床医学院，山东潍坊 261000；2.聊城市人民医院内分泌科，山东聊城 252000；3.聊城市人民医院中西医结合儿科重点实验室，山东聊城 252000；4.聊城市人民医院精准生物医学重点实验室，山东聊城 252000；5.首都医科大学宣武医院中心实验室，北京 100053；6.聊城市东昌府人民医院内分泌科，山东聊城 252000
  • 收稿日期:2025-12-22 修回日期:2026-01-27 出版日期:2026-04-21 发布日期:2026-04-21
  • 通讯作者: 赵咏梅,李森 E-mail:zhaoym@ccmu.edu.cn; lisendr@126.com
  • 基金资助:
    国家自然科学基金项目（81971095），山东第二医科大学附属医院科研发展基金项目（2024FYM125）。

Association between the triglyceride-high density lipoprotein-cholesterol-glucose body  index and stroke risk in middle-aged and  elderly population  in China

Wang Weisheng1，2  , Wang Ting3,   Song Shiyu1,   Fu Bo4,   Zhao Yongmei5*#,   Li Sen2，6*#   

  1. 1.School of Clinical Medicine, Shandong Second Medical University, Weifang 261000, Shandong Province, China; 2. Department of Endocrinology, Liaocheng People's Hospital, Liaocheng 252000, Shandong Province, China; 3. Key Laboratory for Pediatrics of Integrated Traditional and Western Medicine, Liaocheng People's Hospital, Liaocheng 252000, Shandong Province, China; 4. Key Laboratory of Precision Biomedicine, Liaocheng People's Hospital, Liaocheng 252000, Shandong Province, China; 5. Central Laboratory, Xuanwu Hospital, Capital Medical University, Beijing 100053,China; 6. Department of Endocrinology, Liaocheng Dongchangfu People's Hospital, Liaocheng 252000, Shandong Province, China
  • Received:2025-12-22 Revised:2026-01-27 Online:2026-04-21 Published:2026-04-21
  • Supported by:
    This study was supported by National Natural Science Foundation of China ( 81971095)， Science and Technology Development Project of the Affiliated Hospital of Shandong Second Medical University（2024FYM125）.

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摘要： 目的  探讨新型复合代谢指标三酰甘油-高密度脂蛋白胆固醇-葡萄糖体指数（triglyceride-high density lipoprotein choles terol-glucose body index，TyHGB）与中国中老年人群卒中发病风险的关联。方法  基于中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS），纳入7 064例45岁及以上无卒中史的中老年人，随访9年,并利用医院临床队列（n=204）进行验证。通过Cox比例风险回归模型评估TyHGB与卒中的关联性，亚组分析和限制性立方样条（restricted cubic spline，RCS）模型探讨其相互作用和剂量-反应关系，受试者工作特征（receiver operating characteristic，ROC）曲线评估TyHGB对卒中风险的预测价值。 结果  多变量调整后，TyHGB每升高1个单位，卒中发病风险 CHARLS队列中增加 18%（HR=1.18，95% CI：1.11~1.25，P<0.001），在医院验证队列中增加 38%（HR=1.38，95% CI：1.09~1.75，P=0.008）。RCS分析提示二者关联形态存在人群异质性，CHARLS队列中呈非线性关系，而医院队列中更趋近于线性，但两队列均一致支持TyHGB与卒中风险的正向关联。ROC曲线表明TyHGB在预测中国中老年人群卒中发病风险方面具有中等能力，其预测卒中风险的曲线下面积(area under the curve，AUC)在CHARLS队列中为 0.578，在医院队列中为 0.753，且均显著优于传统三酰甘油-葡萄糖(triglyceride-glucose，TyG) 指数（P 均<0.05）。TyHGB与卒中发病风险的正向关联在不同人口统计学及临床特征亚组中均保持一致。 结论  TyHGB与中国中老年人群卒中发病风险呈显著正相关，且在CHARLS全国性队列与医院临床队列中均表现出优于传统TyG指数的预测效能。其在社区人群中的非线性关联与临床队列中的稳健性共同提示，TyHGB是一种可靠、便捷的卒中风险初筛工具，适用于不同场景的人群风险评估与一级预防策略制定。

关键词: 三酰甘油, 高密度脂蛋白胆固醇, 体质量指数, CHARLS, 中老年, 卒中

Abstract: Objective  To explore the association between the novel composite metabolic index triglyceride-high density lipoprotein-cholesterol-glucose body index(TyHGB) and the risk of stroke incidence in the middle-aged and elderly population in China. Methods  Based on the China Health and Retirement Longitudinal Study (CHARLS), 7 064 middle-aged and elder adults aged ≥ 45 years with no prior history of stroke were enrolled and followed up for 9 years，with additional validation performed using a hospital-based clinical cohort (n=204). The Cox proportional hazards regression model was employed to evaluate the association between TyHGB and the incidence of stroke. Subgroup analyses and restricted cubic spline (RCS) models were utilized to investigate potential interactions and nonlinear dose-response relationships. Additionally, receiver operating characteristic (ROC) curves were used to assess the predictive value of TyHGB in relation to stroke risk. Results  Following multivariable adjustment, each 1-unit increase in TyHGB was associated with an 18% elevated risk of stroke in the CHARLS cohort (HR=1.18, 95% CI: 1.11－1.25, P<0.001) and a 38% increased risk in the hospital validation cohort (HR=1.38, 95% CI: 1.09－1.75, P =0.008). RCS analysis revealed population heterogeneity in the association pattern, showing a nonlinear relationship in the CHARLS cohort but an approximately  linear trend in the hospital cohort. Nevertheless, both cohorts consistently supported a positive association between TyHGB and stroke risk. ROC curves suggested that TyHGB had moderate capability in predicting stroke risk among middle-aged and elder Chinese adults, with area under the curve (AUC) of 0.578 in the CHARLS cohort and 0.753 in the hospital cohort. TyHGB was significantly superior to the conventional TyG (triglyceride-glucose) index in both cohorts (both P<0.05). The positive association between TyHGB and incident stroke risk remained robust across various demographic and clinical subgroups. Conclusion  TyHGB is significantly positively associated with stroke risk in middle-aged and elder Chinese adults, and it exhibits superior predictive efficacy compared to the conventional TyG index in both the nationally representative CHARLS cohort and the hospital-based clinical cohort. The nonlinear association observed in the community population, combined with its robustness in the clinical cohort, collectively suggests that TyHGB serves as a reliable and convenient preliminary screening tool for stroke risk assessment. It is applicable for population risk evaluation and primary prevention strategy development across different scenarios.

Key words: triglyceride, high density lipoprotein-cholesterol, body mass index, CHARLS, middle-aged and elderly,  stroke

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