甘油三酯-葡萄糖指数与夜间高血压的关联及其识别不同夜间高血压临床表型的价值

The triglyceride-glucose index and nocturnal hypertension: association and utility for discriminating clinical phenotypes

摘要

目的 探讨甘油三酯-葡萄糖指数（TyG 指数）与夜间高血压（NH）之间的关系，以及 TyG 指数识别不同 NH 表型的价值。方法 本研究收集了 2023 年 9 月至 2025 年 7 月期间，天津康汇医院高血压科就诊的 1 492 例患者资料进行横断面分析。根据 24 h 动态血压监测和是否服用抗高血压药结果分为四组：单纯夜间高血压（INH）组、日间-夜间持续性高血压组、其他 NH 组（包括正在接受降压治疗且日间血压控制达标但夜间血压升高者、NH 延续至清晨高血压者，以及老年直立性低血压合并夜间卧位高血压者）和夜间血压正常组。采集人口学资料、生活方式、病史、实验室指标并计算 TyG 指数。采用 logistic 回归评估 TyG 指数与及不同临床表型的独立关联，并进行交互与分层分析；限制性立方样条检验非线性关系；受试者操作特征（ROC）曲线、校准曲线及决策曲线分析评价区分价值、校准效能及临床净获益。结果 夜间血压正常组与 NH 各组在人口学特征、既往病史、血压参数、代谢指标上四组间总体差异显著（均 P＜0.05）。多因素无序 logistic 回归结果显示，调整相关因素后，TyG 指数每增加 1 单位，INH、日夜持续性高血压与其他 NH 的 OR 分别为 7.14（95%CI: 4.82～10.59）、4.70（3.39～6.53）、3.99（2.88～5.51）。分层分析提示该关联在女性和年龄 ≥ 65 岁人群中更强。限制性立方样条曲线分析显示，TyG 指数与 INH 风险呈线性关系（校正后 P_非线性 = 0.755），而与其他 NH 表型存在非线性递增趋势。ROC 分析表明，TyG 指数对不同 NH 类型均具有区分价值，其中对 INH 的区分效能最佳（AUC = 0.814，95%CI: 0.778～0.850）。校准曲线和决策曲线支持 TyG 指数联合传统危险因素用于 NH 筛查与临床风险分层，在识别 INH 中 TyG 指数可单独使用[Brier 分数:0.167 比 0.144，净获益：0.220～0.706 比 0.280～0.713（阈值 0.200～0.700）]。结论 TyG 指数与多种 NH 表型均呈独立正相关，其中对 INH 的识别效能最高。该关联在女性及老年人群中更为显著，且存在非线性趋势。

Abstract

Objective To investigate the association between the triglyceride-glucose (TyG) index and nocturnal hypertension (NH), and to evaluate its value for identifying different NH phenotypes. Methods This cross-sectional study included 1 492 patients who visited the Hypertension Department of Tianjin Kanghui Hospital between September 2023 and July 2025. Based on 24-hour ambulatory blood pressure monitoring and antihypertensive medication use, participants were categorized into four groups: isolated nocturnal hypertension (INH), sustained day-night hypertension, other forms of NH (including treated patients with controlled daytime but elevated nighttime blood pressure, NH extending to morning hypertension, and elderly patients with orthostatic hypotension accompanied by nocturnal supine hypertension), and normal nocturnal blood pressure. Demographic characteristics, lifestyle factors, medical history, and laboratory parameters were collected to calculate the TyG index. Logistic regression was used to evaluate the independent association between the TyG index and NH as well as its subtypes, followed by interaction and stratified analyses. Restricted cubic spline models were applied to assess potential non-linear relationships. Receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA) were used to evaluate discriminatory performance, calibration, and clinical net benefit. Results Significant overall differences were observed among the four groups in demographic characteristics, medical history, blood pressure parameters, and metabolic indices (all P ＜ 0.05). Multivariate ordinal logistic regression showed that after adjusting for confounders, each 1-unit increase in the TyG index was independently associated with higher odds of INH (OR = 7.14, 95%CI: 4.82 to 10.59), sustained day-night hypertension (OR = 4.70, 95%CI: 3.39 to 6.53), and other NH (OR = 3.99, 95%CI: 2.88 to 5.51). Stratified analysis indicated stronger associations in females and individuals aged ≥ 65 years. Restricted cubic spline analysis revealed a linear relationship between the TyG index and INH risk (adjusted P for non-linear = 0.755), while non-linear increasing trends were observed for other NH phenotypes. ROC analysis demonstrated that the TyG index had good discriminatory ability for all NH types, with the highest performance for INH (AUC = 0.814, 95%CI: 0.778 to 0.850). Calibration and decision curve analyses supported the use of the TyG index combined with traditional risk factors for NH screening and clinical risk stratification, and suggested that the TyG index alone was adequate for identifying INH (Brier score: 0.167 vs. 0.144; net benefit: 0.220 to 0.706 vs. 0.280 to 0.713 at thresholds of 0.200 to 0.700). Conclusion The TyG index is independently and positively associated with multiple NH phenotypes, with the strongest predictive value for INH. This association is more pronounced in women and older adults and demonstrates a potential non-linear pattern across different NH types.

关键词

夜间高血压 / 单纯夜间高血压 / 临床表型 / 甘油三酯-葡萄糖指数

Key words

nocturnal hypertension / isolated nocturnal hypertension / clinical phenotype / triglyceride–glucose index

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基金资助

中华医学会心血管病学分会临床研究专项基金(CSCF2023A02)