心脏代谢指标对成人糖尿病前期进展为糖尿病和血糖恢复正常的预测性能：一项队列研究
Predictive performance of cardiometabolic indices for prediabetes progression to diabetes and reversion to normoglycemia in adults: a cohort study.
摘要(中文译文)
为评估心脏代谢指标与糖尿病前期进展和逆转的关联，并识别在风险分层中具有相对更优判别性能的无创标志物，我们分析了大连健康管理队列中35,525名糖尿病前期成人（年龄≥18岁）。采用Cox比例风险模型和限制性立方样条（RCS）评估心脏代谢指标与糖尿病前期进展和逆转的关联。使用时间依赖性受试者工作特征（ROC）曲线比较相对判别性能，随后进行中介分析和亚组分析。在90,810.98人年的随访中，3,125名（8.8%）参与者进展为糖尿病，13,605名（38.8%）逆转为正常血糖。经过多变量调整和标准化后，甘油三酯葡萄糖-腰高比（TyG-WHtR）在所评估的指标中表现出最强的关联（进展：HR = 2.15，95% CI：2.06-2.24；逆转：HR = 0.60，95% CI：0.59-0.62），且时间依赖性ROC分析以及C指数、NRI和IDI的计算支持其具有相对更优的判别性能。中介分析表明，γ-谷氨酰转肽酶（GGT）和中性粒细胞计数通过潜在的间接途径，在与糖尿病前期进展（分别为8.26%和3.88%）和逆转（分别为4.05%和0.80%）的关联中占较小比例。心脏代谢指标与糖尿病前期进展为糖尿病及逆转为正常血糖相关，其中TyG-WHtR在该队列中显示出相对更优的判别性能。炎症和氧化应激可能是上述关联的潜在途径。
Abstract
To evaluate the associations of cardiometabolic indices with prediabetes progression and reversal and to identify noninvasive markers with relatively better discriminatory performance for risk stratification. We analyzed 35,525 adults (aged ≥18 years) with prediabetes from the Dalian Health Management Cohort. Associations of cardiometabolic indices with prediabetes progression and reversal were assessed using Cox proportional hazards models and restricted cubic splines (RCS). Relative discriminatory performance was compared using time-dependent receiver operating characteristic (ROC) curves, and mediation and subgroup analyses were subsequently performed. Over 90,810.98 person-years, 3,125 (8.8%) participants progressed to diabetes, and 13,605 (38.8%) reverted to normoglycemia. After multivariable adjustment and standardization, triglyceride glucose-waist height ratio (TyG-WHtR) exhibited the strongest associations among the evaluated indicators (progression: HR = 2.15, 95% CI: 2.06-2.24; reversal: HR = 0.60, 95% CI: 0.59-0.62) and relatively better discriminatory performance, as supported by time-dependent ROC analysis and the calculation of C-index, NRI, and IDI. Mediation analysis indicated that gamma-glutamyl transpeptidase (GGT) and neutrophil count accounted for modest proportions of the associations with prediabetes progression (8.26 and 3.88%, respectively) and reversal (4.05 and 0.80%, respectively) through potential indirect pathways. Cardiometabolic indices are associated with prediabetes progression to diabetes and reversal to normoglycemia, with TyG-WHtR showing relatively better discriminatory performance in this cohort. Inflammation and oxidative stress may represent potential pathways underlying the aforementioned associations.
如何引用
AMA
Yilin Zhu, Yangxuan He, Shusheng Fang, Hong Chen, Jingshan Jiang, Yunxiang Ming, et al. Predictive performance of cardiometabolic indices for prediabetes progression to diabetes and reversion to normoglycemia in adults: a cohort study.. Frontiers in nutrition. 2026; doi:10.3389/fnut.2026.1784247.
APA
Yilin Zhu, Yangxuan He, Shusheng Fang, Hong Chen, Jingshan Jiang, Yunxiang Ming, et al (2026). Predictive performance of cardiometabolic indices for prediabetes progression to diabetes and reversion to normoglycemia in adults: a cohort study.. Frontiers in nutrition. https://doi.org/10.3389/fnut.2026.1784247
GB/T 7714
Yilin Zhu, Yangxuan He, Shusheng Fang, Hong Chen, Jingshan Jiang, Yunxiang Ming, et al. Predictive performance of cardiometabolic indices for prediabetes progression to diabetes and reversion to normoglycemia in adults: a cohort study.[J]. Frontiers in nutrition, 2026 doi:10.3389/fnut.2026.1784247.
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