鲍巧玲,汪晓洲

冠心病（CAD）的发病机制与慢性代谢紊乱及急性应激反应的动态交互密切相关。近年来，甘油三酯葡萄糖指数（TyG指数）和应激性高血糖比（SHR）作为新型生物标志物，分别从胰岛素抵抗（IR）和急性糖代谢失衡维度为CAD风险分层提供了新视角。TyG指数通过整合空腹甘油三酯与血糖水平评估慢性代谢紊乱，而SHR通过量化应激性高血糖与慢性血糖稳态的失衡，反映急性血管损伤风险。研究表明，二者在CAD预测中展现出显著协同效应。然而，人群异质性、检测标准化不足及分子机制不明仍是临床转化的核心挑战。未来需依托多模态模型，通过动态监测与精准干预，实现冠心病的个体化防治。

TyG指数；SHR；冠心病

[1] Barquera S,Pedroza-Tobias A,MEDINA C,et al.Global overview of the epidemiology of atherosclerotic cardiovascular disease[J].Arch Med Res,2015,46(5):328-338. [2] Akimova V,Demianchuk N,Shchurko M,et al.Changes in metabolic parameters in ischemic heart disease against the background of metabolic syndrome[J].ScienceRise:Medical Science,2023(3(54)):4-7. [3] Mingyang Li,Xiaodong Cui,Yan Zhang,et al.The relative and combined ability of triglyceride-glucose index and stress hyperglycemia ratio to predict major adverse cardio-cerebral events in patients with multivessel coronary artery disease.Diabetol Metab Syndr 2024,16(1),234. [4] Simental-Mendía L E,Rodríguez-Morán M,Guerrero-Romero F.The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects[J].Metabolic syndrome and related disorders,2008,6(4):299-304. [5] Xu W,Wang X,Xia C,et al.The Role of SHR in Risk Stratification for Long-Term Prognosis in Patients with Coronary Artery Disease: Findings from a Large Cohort Study[J].Frontiers in Endocrinology,16:1640725. [6] Bailin S S,Ma S,Perry A S,et al.The primacy of adipose tissue gene expression and plasma Lipidome in Cardiometabolic disease in persons with HIV[J].The Journal of Infectious Diseases,2025,231(2):e407-e418. [7] Li L,Zhao M,Zhang Z,et al.Prognostic significance of the stress hyperglycemia ratio in critically ill patients[J].Cardiovascular Diabetology,2023,22(1):275. [8] González-Carnicero Z,Hernanz R,Martínez-Casales M,et al.Regulation by Nrf2 of IL-1β-induced inflammatory and oxidative response in VSMC and its relationship with TLR4[J].Frontiers in Pharmacology,2023,14:1058488. [9] Zhu L,Liu Y,Wang K,et al.Regulated cell death in acute myocardial infarction:Molecular mechanisms and therapeutic implications[J]. Ageing research reviews,2025,104:102629. [10] Kondapalli N,Katari V,Dalal K K,et al.Microbiota in Gut‐Heart Axis:Metabolites and Mechanisms in Cardiovascular Disease[J]. Comprehensive Physiology,2025,15(3):e70024. [11] Sawaf B.,Swed S.,Alibrahim H.,et al.Triglyceride-Glucose Index as Predictor for Hypertension,CHD and STROKE Risk among Non- Diabetic Patients:A NHANES Cross-Sectional Study 2001-2020.J Epidemiol Glob Health 2024,14(3),1152-1166. [12] Jinyu Su,Zhu Li,Mengnan Huang,et al.Triglyceride glucose index for the detection of the severity of coronary artery disease in different glucose metabolic states in patients with coronary heart disease:a RCSCD-TCM study in China.Cardiovasc Diabetol 2022,21(1),96. [13] Patricio Lopez-Jaramillo,Diego Gomez-Arbelaez,Daniel Martinez-Bello,et al.Association of the triglyceride glucose index as a measure of insulin resistance with mortality and cardiovascular disease in populations from five continents(PURE study):a prospective cohort study.Lancet Healthy Longev 2023,4(1),e23-e33. [14] Erfei Luo,Dong Wang,Gaoliang Yan,et al.High triglyceride-glucose index is associated with poor prognosis in patients with acute ST- elevation myocardial infarction after percutaneous coronary intervention.Cardiovasc Diabetol 2019,18(1),150. [15] Yu Zhang,Haiyan Song,Jing Bai,et al.Association between the stress hyperglycemia ratio and severity of coronary artery disease under different glucose metabolic states.Cardiovasc Diabetol 2023,22(1),29. [16] Kui Li,Xueyuan Yang,Yunhang Li,et al.Relationship between stress hyperglycaemic ratio and incidence of in-hospital cardiac arrest in patients with acute coronary syndrome:a retrospective cohort study.Cardiovasc Diabetol 2024,23(1),59. [17] Zheng Qiao,Xiaohui Bian,Chenxi Song,et al.High stress hyperglycemia ratio predicts adverse clinical outcome in patients with coronary three-vessel disease:a large-scale cohort study.Cardiovasc Diabetol 2024,23(1),190. [18] Roberts GW,Quinn SJ,Valentine N,Alhawassi T,O'Dea H,Stranks SN,Burt MG,Doogue MP.Relative Hyperglycemia,a Marker of Critical Illness:Introducing the Stress Hyperglycemia Ratio[J].J Clin Endocrinol Metab.2015.100(12):4490-4497. [19] Yang Y,Kim TH,Yoon KH,Chung WS,Ahn Y,Jeong MH,Seung KB,Lee SH,Chang K.The stress hyperglycemia ratio,an index of relative hyperglycemia,as a predictor of clinical outcomes after percutaneous coronary intervention[J].Int JCardiol.2017.241:57-63. [20] Yanjun Song,Kongyong Cu,Min Yang,et al.High triglyceride-glucose index and stress hyperglycemia ratio as predictors of adverse cardiac events in patients with coronary chronic total occlusion:a large-scale prospective cohort study.Cardiovasc Diabetol 2023,22(1),180.

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