甘油三酯葡萄糖体质量指数与膀胱过度活动症之间的相关性分析

Correlation between triglyceride glucose-body mass index and overactive bladder

摘要

目的 探讨美国成年人群中甘油三酯葡萄糖体质量指数（TyG-BMI）与膀胱过度活动症（OAB）之间的相关性，从胰岛素抵抗与肥胖协同作用的综合代谢视角，为OAB的代谢危险分层、早期筛查与干预提供参考。方法 采用横断面研究，基于2005-2020年美国国家健康与营养检查调查（NHANES）数据选取16 729名参与者作为研究对象。按四分位数法将TyG-BMI作为分类变量，采用多因素logistic回归分析TyG-BMI与OAB患病风险之间的关系。采用限制性立方样条（RCS）检验TyG-BMI与OAB之间的非线性关联。根据参与者的临床特征进行分层，采用多因素logistic回归评估各亚组内TyG-BMI与OAB之间的关联。结果 TyG-BMI升高与OAB患病风险增加呈显著正相关（P＜0.000 1）。将TyG-BMI按四分位数分组后，在完全校正模型中，与最低四分位数（Q₁）组相比，最高四分位数（Q₄）组的OAB风险显著升高（OR=2.00，95%CI:1.73～2.30，P＜0.000 1）。RCS分析显示TyG-BMI与OAB发生风险之间存在非线性剂量-反应关系（P非线性＜0.05）。亚组分析显示，该关联在女性、＜55岁、无高血压及无社会保险人群中更为显著（P交互＜0.05）。结论 基于2005-2020年美国NHANES的研究显示，TyG-BMI升高与OAB患病风险增加呈独立正相关关系，TyG-BMI作为简便易得的综合代谢指标，可为OAB高风险人群的早期识别与代谢相关干预策略的制定提供参考。

Abstract

Objective To investigate the association between the triglyceride glucose-body mass index(TyG-BMI) and overactive bladder(OAB) among US adults, and to provide evidence for metabolic risk stratification, early screening and targeted intervention for OAB from an integrated metabolic perspective incorporating insulin resistance and obesity. Methods Data were obtained from the National Health and Nutrition Examination Survey(NHANES) 2005-2020, including 16 729 eligible participants. This cross-sectional study assessed TyG-BMI as a categorical variable by quartiles. The association between TyG-BMI and OAB was evaluated with multivariable logistic regression models. The potential nonlinear association was examined with restricted cubic spline(RCS). Subgroup analyses were performed by stratifying participants according to clinical characteristics, and multivariable logistic regression was conducted within each subgroup. Results Higher TyG-BMI was significantly associated with an increased risk of OAB(P＜0.000 1). In the fully adjusted model, participants in the highest quartile(Q₄) had a significantly higher risk of OAB than those in the lowest quartile(Q₁) (OR=2.00, 95%CI: 1.73-2.30, P＜0.000 1). RCS analyses indicated a nonlinear dose-response relationship between TyG-BMI and OAB(P_nonlinearity ＜0.05). Subgroup analyses showed that the association was more pronounced among females, participants aged ＜55 years, those without hypertension, and uninsured individuals (P_interaction ＜0.05). Conclusion Based on NHANES 2005-2020 data, higher TyG-BMI was independently associated with an increased risk of OAB. As a convenient and readily available composite metabolic indicator, TyG-BMI may help identify individuals with high risk of OAB and provide evidence for the development of metabolism-related intervention strategies.

关键词

膀胱过度活动症 / 甘油三酯葡萄糖体质量指数（TyG-BMI） / 胰岛素抵抗 / 美国国家健康与营养检查调查（NHANES） / 代谢综合征

Key words

overactive bladder / triglyceride glucose-body mass index / insulin resistance / National Health and Nutrition Examination Survey / metabolic syndrome

参考文献

[1] SEBESTA EM, GLEICHER S, KAUFMAN MR, et al. Associations between unmet social needs and overactive bladder[J]. J Urol, 2022, 208(5): 1106-1115.

[2] WANG Y, XU K, HU H, et al. Prevalence, risk factors, and impact on health related quality of life of overactive bladder in China[J]. Neurourol Urodyn, 2011, 30(8): 1448-1455.

[3] MCKELLAR K, BELLIN E, SCHOENBAUM E, et al. Prevalence, risk factors, and treatment for overactive bladder in a racially diverse population[J]. Urology, 2019, 126: 70-75.

[4] BUNN F, KIRBY M, PINKNEY E, et al. Is there a link between overactive bladder and the metabolic syndrome in women? A systematic review of observational studies[J]. Int J Clin Pract, 2015, 69(2): 199-217.

[5] HE Q, WANG Z, LIU G, et al. Metabolic syndrome, inflammation and lower urinary tract symptoms: possible translational links[J]. Prostate Cancer Prostatic Dis, 2016, 19(1): 7-13.

[6] 黄佳琪， 王子健， 李莹， 等. 甘油三酯葡萄糖-体重指数与糖尿病发病风险的队列研究[J]. 国际内分泌代谢杂志， 2024，44（6）: 398-404.

[7] 程钰， 张姝， 李娇艳， 等. 联合应用中国内脏肥胖指数和甘油三酯-葡萄糖指数评估社区人群新发心血管疾病风险的研究[J]. 中华糖尿病杂志， 2025，17（5）: 592-600.

[8] 张沥， 陈海滨， 宋俊华. TyG-BMI对非酒精性脂肪性肝病的预测价值分析[J]. 中华保健医学杂志， 2023，25（2）: 151-154.

[9] ROHM TV, MEIER DT, OLEFSKY JM, et al. Inflammation in obesity, diabetes, and related disorders[J]. Immunity, 2022, 55(1): 31-55.

[10] AMARENCO G, SERIKOFF A, CHARTIER-KASTLER E, et al. Metabolic syndrome and urinary disorders[J]. Prog Urol, 2012, 22(4): 207-213. In French.

[11] HASHIMOTO M, SHIMIZU N, NISHIMOTO M, et al. Sarcopenia and visceral obesity are significantly related to severe storage symptoms in geriatric female patients[J]. Res Rep Urol, 2021, 13: 557-563.

[12] PEYRONNET B, MIRONSKA E, CHAPPLE C, et al. A comprehensive review of overactive bladder pathophysiology: on the way to tailored treatment[J]. Eur Urol, 2019, 75(6): 988-1000.

[13] 杨春晓， 杨林波， 刘明， 等. 哮喘与女性夜尿症的相关性:2005-2018年NHANES数据分析[J]. 现代泌尿外科杂志， 2025，30（2）: 118-121， 142.

[14] HUI Z, ZEWU Z, YANG L, et al. Association between weight-adjusted waist index and overactive bladder: a cross-sectional study based on 2009-2018 NHANES[J]. Front Nutr, 2024, 11: 1423148.

[15] ZHANG Y, WU X, LIU G, et al. Association between overactive bladder and depression in American adults: a cross-sectional study from NHANES 2005-2018[J]. J Affect Disord, 2024, 356: 545-553.

[16] CAO S, HU X, TANG Y, et al. Weight-adjusted-waist index is positively associated with urinary incontinence: results from the National Health and Nutrition Examination Survey (NHANES) 2001-2018[J]. Eur J Med Res, 2024, 29(1): 368.

[17] ER LK, WU S, CHOU HH, et al. Triglyceride glucose-body mass index is a simple and clinically useful surrogate marker for insulin resistance in nondiabetic individuals[J]. PLoS ONE, 2016, 11(3): e0149731.

[18] LIM J, KIM J, KOO SH, et al. Comparison of triglyceride glucose index, and related parameters to predict insulin resistance in Korean adults: an analysis of the 2007-2010 Korean national health and nutrition examination survey[J]. PLoS ONE, 2019, 14(3): e0212963.

[19] YANG X, LI K, WEN J, et al. Association of the triglyceride glucose-body mass index with the extent of coronary artery disease in patients with acute coronary syndromes[J]. Cardiovasc Diabetol, 2024, 23(1): 24.

[20] DU Z, XING L, LIN M, et al. Estimate of prevalent ischemic stroke from triglyceride glucose-body mass index in the general population[J]. BMC Cardiovasc Disord, 2020, 20(1): 483.

[21] WANG F, HE T, WANG G, et al. Association of triglyceride glucose-body mass index with non-small cell lung cancer risk: a case-control study on Chinese adults[J]. Front Nutr, 2022, 9: 1004179.

[22] WEN Z, LI Y, XU L, et al. Triglyceride glucose-body mass index is a reliable indicator of bone mineral density and risk of osteoporotic fracture in middle-aged and elderly nondiabetic Chinese individuals[J]. J Clin Med, 2022, 11(19): 5694.

[23] UZUN H, YILMAZ A, KEMIK A, et al. Association of insulin resistance with overactive bladder in female patients[J]. Int Neurourol J, 2012, 16(4): 181-186.

[24] NAZZAL Z, KHATIBB B, AL-QUQA B, et al. The prevalence and risk factors of urinary incontinence among women with type 2 diabetes in the north West Bank: a cross-sectional study[J]. Lancet, 2021, 398(1): S42.

[25] CHENG Z, TSENG Y, WHITE MF. Insulin signaling meets mitochondria in metabolism[J]. Trends Endocrinol Metab, 2010, 21(10): 589-598.

[26] NOCCHI L, DALY DM, CHAPPLE C, et al. Induction of oxidative stress causes functional alterations in mouse urothelium via a TRPM8-mediated mechanism: implications for aging[J]. Aging Cell, 2014, 13(3): 540-550.

[27] BLAHA I, LOPEZ-OLIVA ME, MARTINEZ MP, et al. Bladder dysfunction in an obese zucker rat: the role of TRPA1 channels, oxidative stress, and hydrogen sulfide[J]. Oxid Med Cell Longev, 2019, 2019: 5641645.

[28] HAYLEN BT, DE RIDDER D, FREEMAN RM, et al. International urogynecological association; international continence society. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction[J]. Neurourol Urodyn, 2010, 29(1): 4-20.

[29] DIOKNO AC, NEWMAN DK, LOW LK, et al. Effect of group-administered behavioral treatment on urinary incontinence in older women: a randomized clinical trial[J]. JAMA Intern Med, 2018, 178(10): 1333-1341.