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已发表论文
COPD合并心房颤动住院患者中TyG指数与缺血性卒中的负相关：一项回顾性分析
Authors Chen S, Luo C, You C , Xiong Y, Ye X , Tang Y, Zhang X
Received 6 August 2025
Accepted for publication 8 January 2026
Published 17 January 2026 Volume 2026:21 558402
DOI https://doi.org/10.2147/COPD.S558402
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Prof. Dr. Richard Russell
Siyi Chen,1 Chao Luo,2,* Caixia You,1,* Yanliang Xiong,1,* Xiaoqun Ye,1 Yanhua Tang,2 Xinyi Zhang1
1Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, People’s Republic of China; 2Department of Cardiovascular Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Yanhua Tang, Email tyh6565@163.com Xinyi Zhang, Email zhangxinyi80@163.com
Purpose: Patients with chronic obstructive pulmonary disease (COPD) and atrial fibrillation (AF) face elevated ischemic stroke (IS) risk. This study assessed the triglyceride-glucose (TyG) index as a metabolic marker for IS risk in this population.
Patients and Methods: This retrospective analysis included 710 hospitalized patients with COPD and AF (2014– 2024). The TyG index (ln[fasting triglycerides (mg/dL)×fasting glucose (mg/dL)/2]) measured at admission was the exposure; new-onset IS occurring during the index hospitalization (median duration: 9 days, IQR: 6– 13) was the outcome. Univariate and multivariate logistic regression (adjusting for age, sex, smoking, blood pressure, diabetes, lipids, prior stroke) identified associations. Nonlinearity was assessed using generalized additive models (GAM). Predictive performance was evaluated via ROC analysis (AUC).
Results: IS occurred in 32 patients (4.5%). Unexpectedly, and in contrast to findings in the general population, higher TyG index was associated with lower IS risk in univariate analysis (OR=0.49, 95% CI:0.26– 0.94). After full adjustment, each unit increase in TyG index was associated with lower IS risk (aOR=0.24, 95% CI:0.10– 0.57, P=0.001). However, the wide confidence interval and limited events (n=32) indicate this large effect estimate should be interpreted cautiously, as it may reflect statistical instability. The finding suggests a potential metabolic paradox in this population. GAM confirmed a linear inverse relationship after adjusting for stroke history (OR=0.50, 95% CI:0.30– 0.90, P=0.032). The TyG index predicted IS with an AUC of 0.614 (95% CI:0.513– 0.715).
Conclusion: Contrary to observations in the general population, in hospitalized COPD and AF patients, a higher TyG index was associated with lower short-term ischemic stroke risk. However, this inverse association could reflect either a true inverse metabolic relationship or reverse causality whereby low TyG marks disease severity (malnutrition, poor metabolic reserve, chronic inflammation). Lack of comprehensive disease severity and nutritional assessments limits causal inference. The TyG index may serve as a potential biomarker in hospitalized patients, but population-based studies are essential to address selection bias.
Keywords: triglyceride-glucose index, COPD, atrial fibrillation, ischemic stroke, predictive value
1Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, People’s Republic of China; 2Department of Cardiovascular Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Yanhua Tang, Email tyh6565@163.com Xinyi Zhang, Email zhangxinyi80@163.com
Purpose: Patients with chronic obstructive pulmonary disease (COPD) and atrial fibrillation (AF) face elevated ischemic stroke (IS) risk. This study assessed the triglyceride-glucose (TyG) index as a metabolic marker for IS risk in this population.
Patients and Methods: This retrospective analysis included 710 hospitalized patients with COPD and AF (2014– 2024). The TyG index (ln[fasting triglycerides (mg/dL)×fasting glucose (mg/dL)/2]) measured at admission was the exposure; new-onset IS occurring during the index hospitalization (median duration: 9 days, IQR: 6– 13) was the outcome. Univariate and multivariate logistic regression (adjusting for age, sex, smoking, blood pressure, diabetes, lipids, prior stroke) identified associations. Nonlinearity was assessed using generalized additive models (GAM). Predictive performance was evaluated via ROC analysis (AUC).
Results: IS occurred in 32 patients (4.5%). Unexpectedly, and in contrast to findings in the general population, higher TyG index was associated with lower IS risk in univariate analysis (OR=0.49, 95% CI:0.26– 0.94). After full adjustment, each unit increase in TyG index was associated with lower IS risk (aOR=0.24, 95% CI:0.10– 0.57, P=0.001). However, the wide confidence interval and limited events (n=32) indicate this large effect estimate should be interpreted cautiously, as it may reflect statistical instability. The finding suggests a potential metabolic paradox in this population. GAM confirmed a linear inverse relationship after adjusting for stroke history (OR=0.50, 95% CI:0.30– 0.90, P=0.032). The TyG index predicted IS with an AUC of 0.614 (95% CI:0.513– 0.715).
Conclusion: Contrary to observations in the general population, in hospitalized COPD and AF patients, a higher TyG index was associated with lower short-term ischemic stroke risk. However, this inverse association could reflect either a true inverse metabolic relationship or reverse causality whereby low TyG marks disease severity (malnutrition, poor metabolic reserve, chronic inflammation). Lack of comprehensive disease severity and nutritional assessments limits causal inference. The TyG index may serve as a potential biomarker in hospitalized patients, but population-based studies are essential to address selection bias.
Keywords: triglyceride-glucose index, COPD, atrial fibrillation, ischemic stroke, predictive value