Abstract: Background　Triglyceride-glucose （TyG） index is a simple indicator to evaluate insulin resistance.Previous studies have shown that increased TyG index increases the risk of diabetes，cardiovascular diseases and others，but the relationship between TyG index and the occurrence of albuminuria in patients with type 2 diabetes mellitus （T2DM） has not been determined.Objective　To explore the correlation between TyG index and albuminuria in T2DM patients.Methods　524 T2DM patients with complete records who were treated at the Department of Endocrinology and Metabolism，Affiliated Hospital of Jiangsu University from February 2012 to November 2019 were chosen retrospectively.Clinical data and relevant laboratory examination indices were obtained.According to calculated TyG index tertile，they were divided into low TyG （L-TyG） group （TyG<9.16，n=175），medium TyG （M-TyG） group（9.16≤TyG<9.68，n=175） and high TyG （H-TyG） group （TyG≥9.68，n=174），and in the light of urinary albumin-to-creatinine ratio （UACR），they were divided into normal group （UACR<30 mg/g，n=267），microalbuminuria group （30 mg/g≤UACR<300 mg/g，n=207） and macroalbuminuria group （UACR≥300 mg/g，n=50）.Multiple linear regression was used to analyze the correlation between TyG index and UACR.Multivariate Logistic regression was adopted to determine the relationship between TyG index and albuminuria.The ROC curve of TyG index was drawn to evaluate its predictive value for albuminuria.Results　Correlation analysis showed that TyG index was inversely correlated with T2DM duration and HDL-C （P<0.05），but was positively correlated with BMI，log-transformed HOMA-IR，HbA1c，BUN，TC，LDL-C，SUA，eGFR，and log-transformed UACR （P<0.05）.Multiple linear regression analysis showed that TyG index was independently correlated with log-transformed UACR 〔β=0.443，95%CI （0.373，0.513），P<0.001〕．Multivariate Logistic regression analysis showed that long T2DM duration 〔OR=1.003，95%CI （1.001，1.006）〕，hypertension 〔OR=2.540，95%CI （1.652，3.813）〕，high HbA1c 〔OR=1.194，95%CI （1.079，1.322）〕，high TyG index 〔OR=6.184，95%CI （3.987，9.593）〕，and low HDL-C 〔OR=0.446，95%CI （0.224，0.886）〕 were risk factors for albuminuria （P<0.05）.The AUC of TyG index for predicting albuminuria was 0.834 〔95%CI （0.799，0.865）〕，which was significantly greater than that of log-transformed HOMA-IR，FPG and TG （P<0.001）.When 9.57 was selected as the cut-off value of TyG index，the maximum Youden index was 0.53，the sensitivity was 66.1%，and the specificity was 87.3%.Conclusion　High TyG index is the risk factor for albuminuria in T2DM patients，which is expected to become a new，simple and practical biological predictor of diabetic kidney disease.

Key words: Diabetes mellitus, type 2；Albuminuria；Triglyceride-glucose index；Urinary albumin/creatinine ratio

摘要： 背景　三酰甘油葡萄糖乘积（TyG）指数是一种评估胰岛素抵抗的简易指标，前期研究表明TyG指数升高增加了糖尿病、冠心病等疾病的患病风险，但其与2型糖尿病（T2DM）患者发生白蛋白尿的关系尚未明确。目的　探究TyG指数与T2DM患者发生白蛋白尿的相关性。方法　回顾性选取2012年2月—2019年11月于江苏大学附属医院内分泌代谢科就诊并建立档案的T2DM患者524例，记录其临床资料及相关实验室检查指标水平，并计算TyG指数。根据TyG指数，采用三分位数将患者分为低TyG（L-TyG）组（TyG<9.16，n=175），中TyG（M-TyG）组（9.16≤TyG<9.68，n=175）和高TyG（H-TyG）组（TyG≥9.68，n=174）。并根据尿白蛋白/肌酐比值（UACR）将患者分为正常白蛋白尿组（UACR<30 mg/g，n=267）、微量白蛋白尿组（30 mg/g≤UACR<300 mg/g，n=207）和大量白蛋白尿组（UACR≥300 mg/g，n=50）。采用多元线性回归分析TyG指数与UACR的相关性；采用多因素Logistic回归分析TyG指数与T2DM患者发生白蛋白尿的关系；绘制受试者工作特征（ROC）曲线评估TyG指数对T2DM患者发生白蛋白尿的预测价值。结果　相关性分析结果显示，T2DM患者TyG指数与T2DM病程、高密度脂蛋白胆固醇（HDL-C）呈负相关（P<0.05），与体质指数（BMI）、稳态模型评估胰岛素抵抗指数（lgHOMA-IR）、糖化血红蛋白（HbA1c）、尿素氮（BUN）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、血尿酸（SUA）、估算肾小球滤过率（eGFR）、lgUACR呈正相关（P<0.05）。多元线性回归分析结果显示，TyG指数与lgUACR独立相关〔β=0.443，95%CI（0.373，0.513），P<0.001〕。多因素Logistic回归分析结果显示，T2DM病程长〔OR=1.003，95%CI（1.001，1.006）〕，合并高血压〔OR=2.540，95%CI（1.652，3.813）〕，HbA1c〔OR=1.194，95%CI（1.079，1.322）〕、TyG指数〔OR=6.184，95%CI（3.987，9.593）〕升高，HDL-C下降〔OR=0.446，95%CI（0.224，0.886）〕是T2DM患者发生白蛋白尿的危险因素（P<0.05）。TyG指数预测T2DM患者发生白蛋白尿的ROC曲线下面积为0.834〔95%CI（0.799，0.865）〕，均大于lgHOMA-IR、空腹血糖（FPG）、三酰甘油（TG）（P<0.001）。TyG指数为9.57时，其约登指数最大为0.53，灵敏度为66.1%，特异度为87.3%。结论　TyG指数升高是T2DM患者发生白蛋白尿的危险因素，其有望成为预测糖尿病肾脏疾病风险的新型且简单实用的生物学指标。

关键词: 糖尿病, 2型；白蛋白尿；三酰甘油葡萄糖乘积指数；尿白蛋白/肌酐比值