目的：探讨甘油三酯葡萄糖(TyG)指数、甘油三酯葡萄糖-体质量指数(TyG-BMI)及稳态模型评估胰岛素抵抗(HOMA-IR)指数与糖尿病视网膜病变(DR)的关联以及评估三项指标对DR的诊断价值。

方法：本研究为单中心回顾性研究。选取2023年1月1日至2025年3月1日于三二○一医院内分泌科住院的2型糖尿病(T2DM)患者。根据DR诊断标准将研究对象分为DR组与无DR(NDR)组。分析两组患者的TyG指数、TyG-BMI及HOMA-IR指数与DR的相关性。

结果：本研究共纳入T2DM患者969例，DR组816例中男271例(33.2%)、女545例(66.8%)，平均年龄56.78±11.88岁； NDR组153例中男41例(26.8%)、女112例(73.2%)，平均年龄59.40±10.52岁。DR组与NDR组患者年龄、BMI、TyG指数、TyG-BMI、HOMA-IR指数、FBG、2 h PBG、FINS、2 h PINS、FCP、2 h PCP、CHO、TG、LDL-C、BUN、UA、DBIL、HbA1c、M-TP、MALB、UACR、24 h尿蛋白、WBC、N、PLT比较均有差异(均P<0.05)，其余指标比较均无差异(均P>0.05)。多因素Logistic回归显示，TyG指数\〖aOR=198.65， 95%CI(66.73-591.41)， P<0.001\〗与TyG-BMI\〖aOR=1.03， 95%CI(1.02-1.04)， P<0.001\〗均与DR发生呈正相关，其四分位分组后，随分位升高(Q1-Q4)，DR发生风险持续上升(均P_趋势<0.001)； 未发现HOMA-IR指数与DR相关。多因素调整的限制性立方样条函数分析显示，随着TyG指数升高，DR风险逐渐上升(P_{非线性检验}<0.001)； TyG-BMI与DR风险呈倒“U”形关联(P_{非线性检验}<0.05)； 倾向得分匹配后未发现HOMA-IR指数与DR有关。ROC曲线分析显示，TyG指数、TyG-BMI及HOMA-IR指数诊断DR的曲线下面积(AUC)分别为0.870(95% CI：0.839-0.901)、0.710(95% CI：0.665-0.755)、0.657(95% CI：0.608-0.706)。

结论：TyG指数和TyG-BMI是DR的危险因素。随TyG指数升高，DR风险逐渐上升。TyG-BMI与DR风险呈倒“U”形关联。与TyG-BMI和HOMA-IR指数相比，TyG指数对DR的诊断效能更佳。

METHODS: This study was a single-center retrospective study. Patients with type 2 diabetes mellitus(T2DM)who were hospitalized in the endocrinology department of 3201 Hospital from January 1, 2023 to March 1, 2025 were included. According to the diagnostic criteria for DR, participants were classified into DR group and non-DR(NDR)group. Then the association of TyG index, TyG-BMI, and HOMA-IR index with DR of the two groups of patients were alalyzed.

RESULTS:A total of 969 patients with T2DM were enrolled in this study, including 816 patients in the DR group. Among DR group, 271 were males(33.2%)and 545 were females(66.8%), with a mean age of 56.78±11.88 years. The NDR group consisted of 153 patients, including 41 males(26.8%)and 112 females(73.2%), with a mean age of 59.40±10.52 years. Statistically significant differences were observed between the DR group and the NDR group in terms of age, BMI, TyG index, TyG-BMI, HOMA-IR index, fasting blood glucose(FBG), 2-h postprandial blood glucose(2 hPBG), fasting insulin(FINS), 2-h postprandial insulin(2 hPINS), fasting C-peptide(FCP), 2-h postprandial C-peptide(2 hPCP), total cholesterol(CHO), triglyceride(TG), low-density lipoprotein(LDL-C), blood urea nitrogen(BUN), uric acid(UA), direct bilirubin(DBIL), glycated hemoglobin(HbA1c), milligrams per total protein(M-TP), microalbuminuria(MALB), urinary albumin to creatinine ratio(UACR), 24-hour urine protein, white blood cell(WBC), neutrophil(N), and platelets(PLT; all P<0.05), while no significant differences were found in the remaining indicators(all P>0.05). In multivariable Logistic regression, both TyG index(aOR=198.65, 95% CI: 66.73-591.41, P<0.001)and TyG-BMI(aOR=1.03, 95% CI: 1.02-1.04, P<0.001)remained independently positive associated with DR. Quartile analysis indicated a progressive increase in DR risk with ascending quartiles of TyG index and TyG-BMI(all P_trend<0.001). In contrast, HOMA-IR was not significantly associated with DR. Restricted cubic spline analysis, fully adjusted for confounders, showed a nonlinear upward trend in DR risk with increasing TyG index(P_nonlinearity<0.001), whereas TyG-BMI exhibited a U-shaped association(P_nonlinearity<0.05). No significant association was found between HOMA-IR and DR after propensity score matching. Receiver operating characteristic(ROC)curve demonstrated area under curve(AUC)values of 0.870(95% CI: 0.839-0.901)for TyG index, 0.710(95% CI: 0.665-0.755)for TyG-BMI, and 0.657(95% CI: 0.608-0.706)for HOMA-IR.

CONCLUSION:The TyG index and TyG-BMI are risk factors for DR. A dose-dependent increase in DR risk was associated with elevated TyG index values. TyG-BMI exhibited an inverted U-shaped relationship with DR risk. The TyG index had better diagnostic efficiency for DR compared to both TyG-BMI and HOMA-IR index.