目的 探究累积 TyG 指数( cumTyG) 与结直肠癌( colorectal cacner,CRC) 发病风险之间的关系。 方法 选取 2006、 2008、2010、2012 年度连续参加 3 次开滦集团健康体检的在职及离退休职工作为研究对象。 将研究对象按照 cumTyG 暴露三 分位水平分为 cumTyG1 组(<33. 03)、cumTyG2 组(33. 03~ 36. 69)和 cumTyG3 组(>36. 69)。 结局事件为新发 CRC。 采用 K-M 法计算各组中 CRC 的累积发病率并绘制发病曲线,组间比较采用 log-rank 检验。 采用 Cox 回归模型分析各组 CRC 发生风险 (HR)和 95%置信区间(95%CI)。 排除服用降糖药、降脂药、1 年内发生 CRC 人群对研究结果造成的影响,重复进行 Cox 回归 分析。 使用 C 指数和时间依赖的受试者工作特征曲线( time-roc) 来评估 cumTyG 指数暴露和单次测量的 TyG 指数暴露对 CRC 的诊断效能。 结果 平均随访(10. 13±1. 95)年,cumTyG1 组~ cumTyG3 组的发病密度分别为 4. 23 / 万人年、5. 56 / 万人年和 6. 90 / 万人年,且随着 cumTyG 暴露水平的增加,CRC 累积发病率也呈上升趋势,经 log-rank 检验,差异有统计学意义( χ2 = 15. 31,P<0. 001)。 采用多因素 Cox 回归分析并校正混杂因素,结果显示:与 cumTyG1 组相比,cumTyG2 组、cumTyG3 组发生 CRC 的 HR(95%CI)分别为 1. 20(0. 91~ 1. 57)、1. 36(1. 03~ 1. 81)。 分别剔除服用降糖药、降脂药和 1 年内发生 CRC 人群,重 复进行 Cox 回归分析并校正混杂因素,结果显示:与 cumTyG1 组相比,cumTyG3 组发生 CRC 的风险分别增加 34% (HR = 1. 34,95%CI = 1. 01~ 1. 78)、38%(HR= 1. 38,95%CI = 1. 05 ~ 1. 83)、36%(HR = 1. 36,95%CI = 1. 02 ~ 1. 82)。 C 指数和 time-roc 结果显示:在整个随访过程中,累积 TyG 指数暴露的 AUC 值始终大于单次测量的 TyG 指数暴露,且趋于稳定。 结论 高水平的 cumTyG 暴露是 CRC 的独立危险因素。 cumTyG 暴露对 CRC 的预测价值要强于单次测量的 TyG 指数暴露。

Objective This study aimed to investigate the relationship between cumulative Triglyceride - glucose index cumTyG index and the risk of colorectal cancer CRC . Method Criteria for selecting the subjects were as follows A total of 68 902 in-service and retired employees of Kailuan Group who had attended at three consecutive physical examinations in 2006- 2007 2008- 2009 2010-2011 and 2012-2013. According to the thirdtile of cumulative TyG the participants were divided into three groups namely cumulative TyG1 cumTyG1 cumulative TyG2 cumTyG2 and cumulative TyG3 cumTyG3 . CRC was the primary endpoint. Kaplan-Meier curve was used to calculate the cumulative incidence of CRC in different cumulative TyG groups and log-rank test was used to compare the differences among groups. Cox proportional risk model was used to analyze the impact of different cumTyG and used to exclude people taking hypoglycemic drugs lipid-lowering drugs and CRC events within one year on CRC. C-index and time-dependent receiver operating characteristic curve time - roc were used to assess the diagnostic efficacy of cumTyG index exposure and single-measured TyG index exposure on CRC. Result At average follow-up 10. 13±1. 95 years the incidence density of cumTyG1~ cumTyG3 group was 4. 23 5. 56 and 6. 90 per 10 000 person-years respectively and with the increase of cumTyG exposure level the cumulative incidence of CRC also showed an increasing trend and the difference was statistically significant by og-rank test χ2 = 15. 31 P<0. 001 . Cox proportional hazards model showed that after adjusting for potential confounding factors the HR 95% CI of CRC in the cumTyG2 and cumTyG3 groups were 1. 20 0. 91 1. 57 and 1. 36 1. 03 1. 81 compared with the cumTyG1 group. People taking hypoglycemic drugs lipid-lowering drugs and CRC within 1 year were excluded Cox proportional hazards models and adjusting for potential confounding factors were repeated and the results showed that the risk of CRC in the three groups was increased by 34% HR= 1. 34 95%CI = 1. 01~ 1. 78 38% HR = 1. 38 95%CI = 1. 05 ~ 1. 83 and 36% HR = 1. 36 95%CI = 1. 02~ 1. 82 respectively compared with the cumTyG1 group. The C-index and time-roc results showed that the AUC value of cumulative TyG index exposure was consistently greater than that of single-measured TyG index exposure and tended to be stable throughout the follow-up process. Conclusion High level of cumTyG index exposure is an independent risk factor for CRC. CumTyG exposure has a better predictive value for CRC than single-measured TyG exposure.