Diagnostic Value of the Triglyceride Glucose-body Mass Index for Type 2 Diabetes Mellitus Combined with Metabolic Dysfunction-associated Fatty Liver Disease

doi:10.12114/j.issn.1007-9572.2024.0705

Abstract

Abstract:

Background

The global prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) is rapidly increasing, and its risk significantly inflates when being combined with type 2 diabetes mellitus (T2DM) . The triglyceride glucose-body mass index (TyG-BMI) , as a noninvasive marker of insulin resistance, has demonstrated predictive value for MAFLD in non-diabetic populations, yet its diagnostic efficacy in T2DM patients remains unclear.

Objective

To evaluate the diagnostic utility of TyG-BMI in MAFLD combined with T2DM.

Methods

From 2022 to 2023, a total of 1 347 T2DM patients aged 18 years or above were recruited from the Health Management Center of the People's Hospital of Longhua, Shenzhen. Based on whether combined with MAFLD, patients were divided into two groups: the T2DM-only group (n=601) and the T2DM combined with MAFLD group (n=746) . Clinical data were compared between the two groups. Logistic regression analysis was performed to evaluate the correlations of triglyceride glucose index (TyG) , body mass index (BMI) , and TyG-BMI with T2DM combined with MAFLD. Receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic performance of TyG, BMI, serum uric acid to creatinine ratio (SUA/Scr) , and TyG-BMI in T2DM combined with MAFLD.

Results

Compared with the T2DM-only group, patients in the T2DM combined with MAFLD group showed significantly higher proportion of men, systolic blood pressure (SBP) , diastolic blood pressure (DBP) , total cholesterol (TC) , triglycerides (TG) , aspartate aminotransferase (AST) , alanine aminotransferase (ALT) , uric acid (UA) , fasting plasma glucose (FPG) , glycated hemoglobin (HbA_1c) , BMI, TyG, SUA/Scr, and TyG-BMI levels (P<0.05) , while significantly lower level of blood urea nitrogen (BUN) , high-density lipoprotein cholesterol (HDL-C) and age (P<0.05) . After adjusting for confounders, multivariate Logistic regression analysis showed that TyG (OR=2.989, 95%CI=2.278-3.922, P<0.001) , BMI (OR=1.395, 95%CI=1.324-1.470, P<0.001) , and TyG-BMI (OR=1.039, 95%CI=1.034-1.044, P<0.001) were influencing factors for T2DM combined with MAFLD. ROC curve analysis demonstrated that the sensitivity of TyG, BMI, SUA/Scr, and TyG-BMI in predicting T2DM complicated with MAFLD was 74.7%, 73.7%, 62.0%, and 85.8%, respectively; the specificity was 60.7%, 71.3%, 55.0%, and 66.3%, respectively; and the area under the ROC (AUC) was 0.739, 0.793, 0.608, and 0.833, respectively. The results of Delong test indicated that the AUC of TyG-BMI for T2DM complicated with MAFLD was significantly larger than that of BMI, TyG, and SUA/Scr (Z=8.224, 12.501, and 5.632, respectively; P<0.001) .

Conclusion

TyG, BMI, and TyG-BMI all demonstrate diagnostic value in T2DM complicated with MAFLD. However, TyG-BMI exhibits superior diagnostic value than TyG, BMI, and SUA/Scr.

Key words: Metabolic dysfunction-associated fatty liver disease, Type 2 diabetes mellitus, Triglyceride glucose index, BMI, Triglyceride glucose-body mass index, Insulin resistance, Prediction

摘要：

背景

代谢相关脂肪性肝病（MAFLD）全球患病率快速上升，且与2型糖尿病（T2DM）共病时疾病进展风险显著增加。三酰甘油葡萄糖-体质指数（TyG-BMI）作为胰岛素抵抗的无创标志物，在非糖尿病人群中已证实对MAFLD的预测价值，但其对T2DM患者的诊断效能尚未明确。

目的

探讨TyG-BMI对T2DM合并MAFLD的诊断作用。

方法

2022—2023年，于深圳市龙华区人民医院健康管理中心招募年龄18岁以上的T2DM患者共1 347例。依据T2DM患者是否合并MAFLD，将患者分为单纯T2DM组（601例）、T2DM合并MAFLD组（746例）。比较两组患者临床资料，并采用Logistic回归分析评估三酰甘油葡萄糖指数（TyG）、BMI、TyG-BMI与T2DM合并MAFLD之间的关系。采用受试者工作特征曲线（ROC曲线）分析TyG、BMI、血清尿酸肌酐比值（SUA/Scr）及TyG-BMI对T2DM合并MAFLD的诊断效能。

结果

与单纯T2DM组相比，T2DM合并MAFLD组男性所占比例、收缩压（SBP）、舒张压（DBP）、总胆固醇（TC）、三酰甘油（TG）、天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、尿酸（UA）、空腹血糖（FPG）、糖化血红蛋白（HbA_1c）、BMI、TyG、SUA/Scr、TyG-BMI较高，年龄、高密度脂蛋白胆固醇（HDL-C）、尿素氮（BUN）较低（P<0.05）。调整混杂因素后，多因素Logistic回归分析结果显示，TyG是T2DM合并MAFLD的影响因素（OR=2.989，95%CI=2.278~3.922，P<0.001），BMI是T2DM合并MAFLD的影响因素（OR=1.395，95%CI=1.324~1.470，P<0.001），TyG-BMI是T2DM合并MAFLD的影响因素（OR=1.039，95%CI=1.034~1.044，P<0.001）。ROC曲线分析结果显示，TyG、BMI、SUA/Scr、TyG-BMI预测T2DM合并MAFLD的灵敏度分别为74.7%、73.7%、62.0%、85.8%，特异度分别为60.7%、71.3%、55.0%、66.3%，AUC分别为0.739、0.793、0.608、0.833。Delong检验结果显示，TyG-BMI预测的ROC曲线下面积（AUC）大于BMI、TyG、SUA/Scr预测的AUC（Z=8.224、12.501、5.632，P<0.001）。

结论

TyG、BMI、TyG-BMI对诊断T2DM合并MAFLD均有一定的价值；但与TyG、BMI、SUA/Scr相比，TyG-BMI对T2DM合并MAFLD的诊断价值更高。

YANG Jian,WU Chuan'an,ZHOU Hairong, et al. Diagnostic Value of the Triglyceride Glucose-body Mass Index for Type 2 Diabetes Mellitus Combined with Metabolic Dysfunction-associated Fatty Liver Disease[J]. Chinese General Practice, 2025, 28(32): 4075-4081. DOI: 10.12114/j.issn.1007-9572.2024.0705.
阳坚,吴传安,周海蓉等. 三酰甘油葡萄糖-体质指数对2型糖尿病合并代谢相关脂肪性肝病的诊断价值研究[J]. 中国全科医学, 2025, 28(32): 4075-4081. DOI: 10.12114/j.issn.1007-9572.2024.0705.

Figures/Tables 3

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组别	例数	年龄（岁）	性别（男/女）	SBP （mmHg）	DBP （mmHg）	TG （mmol/L）	TC （mmol/L）	LDL-C （mmol/L）	HDL-C （mmol/L）	ALT （U/L）	TBil （mmol/L）
单纯T2DM组	601	50.3±10.8	387/214	123±18	77±10	1.54±1.33	5.05±1.09	3.21±0.82	1.31±0.29	22.86±27.12	14.55±5.51
T2DM合并MAFLD组	746	49.0±9.4	572/174	129±16	82±10	2.83±2.95	5.20±1.29	3.27±0.83	1.18±0.28	33.90±25.30	14.82±5.59
t（χ²）值		2.43	30.41^a	-6.47	-10.35	-10.66	-2.3	-1.46	8.54	-7.66	-0.86
P值		0.015	<0.001	<0.001	<0.001	<0.001	0.022	0.145	<0.001	<0.001	0.388
组别	AST （U/L）	UA （μmol/L）	Cr （μmol/L）	BUN （mmol/L）	FPG （mmol/L）	HbA_1c （%）	TyG	BMI （kg/m²）	TyG-BMI	SUA/Scr
单纯T2DM组	21.12±13.18	358.76±86.12	75.58± 22.12	5.50±1.59	7.08±2.79	7.25±1.91	8.82±0.72	23.6±2.8	207.63±32.58	4.96±1.37
T2DM合并MAFLD组	25.38±12.93	403.33±105.30	75.96± 20.03	5.31±1.45	8.03±2.99	7.61±1.73	9.48±0.79	26.8±3.3	255.82±39.65	5.51±1.56
t（χ²）值	-5.95	-8.54	-0.33	2.25	-6.02	-3.69	-15.91	-20.69	-24.46	-6.8
P值	<0.001	<0.001	0.742	0.025	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

组别	例数	年龄（岁）	性别（男/女）	SBP （mmHg）	DBP （mmHg）	TG （mmol/L）	TC （mmol/L）	LDL-C （mmol/L）	HDL-C （mmol/L）	ALT （U/L）	TBil （mmol/L）
单纯T2DM组	601	50.3±10.8	387/214	123±18	77±10	1.54±1.33	5.05±1.09	3.21±0.82	1.31±0.29	22.86±27.12	14.55±5.51
T2DM合并MAFLD组	746	49.0±9.4	572/174	129±16	82±10	2.83±2.95	5.20±1.29	3.27±0.83	1.18±0.28	33.90±25.30	14.82±5.59
t（χ²）值		2.43	30.41^a	-6.47	-10.35	-10.66	-2.3	-1.46	8.54	-7.66	-0.86
P值		0.015	<0.001	<0.001	<0.001	<0.001	0.022	0.145	<0.001	<0.001	0.388
组别	AST （U/L）	UA （μmol/L）	Cr （μmol/L）	BUN （mmol/L）	FPG （mmol/L）	HbA_1c （%）	TyG	BMI （kg/m²）	TyG-BMI	SUA/Scr
单纯T2DM组	21.12±13.18	358.76±86.12	75.58± 22.12	5.50±1.59	7.08±2.79	7.25±1.91	8.82±0.72	23.6±2.8	207.63±32.58	4.96±1.37
T2DM合并MAFLD组	25.38±12.93	403.33±105.30	75.96± 20.03	5.31±1.45	8.03±2.99	7.61±1.73	9.48±0.79	26.8±3.3	255.82±39.65	5.51±1.56
t（χ²）值	-5.95	-8.54	-0.33	2.25	-6.02	-3.69	-15.91	-20.69	-24.46	-6.8
P值	<0.001	<0.001	0.742	0.025	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001