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目的 探讨血浆致动脉粥样硬化指数（AIP）、甘油三酯-葡萄糖（TyG）指数与老年2型糖尿病（T2DM）患者合并轻度认知功能障碍（MCI）的关联，构建预测模型，分析AIP、TyG指数对老年T2DM患者合并MCI的预测效能。方法 老年T2DM患者312例，根据蒙特利尔认知评估（MoCA）量表评分及文化程度分为MCI组（136例）和非MCI组（176例）。采用最小绝对收缩和选择算子（LASSO）及多因素Logistic回归筛选变量并构建列线图。采用受试者工作特征（ROC）曲线评估区分度，Bootstrap法重复抽样1 000次进行内部验证，校准曲线及Hosmer-Lemeshow检验评估校准度，决策曲线分析（DCA）评估临床效用。进一步通过净重分类改善指数（NRI）和综合判别改善指数（IDI）评估联合模型（AIP+TyG指数）相比单一指标模型的增量预测效能。结果 AIP和TyG指数是老年T2DM患者合并MCI的独立影响因素（P均＜0.05）。AIP、TyG指数联合预测模型预测老年T2DM患者合并MCI的ROC曲线下面积（AUC）为0.843，最佳截断值为0.407，灵敏度0.824，特异度为0.744。内部验证AUC为0.843，校准良好（Hosmer-Lemeshow检验P=0.602），DCA显示临床净获益。较单一TyG指数或AIP预测模型，联合模型连续NRI分别为0.495、0.364，IDI分别提升0.065、0.021（P均<0.05）。结论 AIP联合TyG指数构建的预测模型对老年T2DM患者合并MCI有一定预测效能，可为门诊初筛及进一步认知功能评估提供参考。
Abstract：Objective Mild cognitive impairment (MCI) imposes a substantial disease burden on older patients with type 2 diabetes mellitus (T2DM)， while outpatient screening methods remain limited. To investigate the associations of the atherogenic index of plasma (AIP) and the triglyceride-glucose (TyG) index with MCI， and to evaluate the discrimination and incremental value of a combined model. Methods A total of 312 older patients with T2DM treated at the First Affiliated Hospital of Bengbu Medical University from September 1， 2024， to March 1， 2026， were included. According to the Montreal Cognitive Assessment (MoCA) scores and educational level， the patients were divided into the MCI and non-MCI groups. Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression were used to select variables and construct a nomogram. Receiver operating characteristic (ROC) curves were used to evaluate discrimination. Internal validation was performed using 1，000 bootstrap resamples. Calibration curves and the Hosmer-Lemeshow test were used to evaluate calibration， and decision curve analysis (DCA) was used to evaluate clinical utility. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were further used to evaluate the incremental predictive value of the combined model incorporating AIP and the TyG index compared with the single-indicator models. Results Among the 312 older patients with T2DM， 136 (43.6%) had MCI， while 176 (56.4%) did not have MCI. AIP (OR=60.322， 95%CI: 8.133-447.390) and the TyG index (OR=2.709， 95%CI: 1.433-5.122) were associated with MCI in older patients with T2DM. The area under the curve of the combined model was 0.843 (95%CI: 0.798-0.888). At the optimal predicted-probability cutoff of 0.407， the model achieved a sensitivity of 82.4% and a specificity of 74.4%. The area under the curve after internal validation was 0.843 (95%CI: 0.797-0.888). The model showed good calibration (Hosmer-Lemeshow test， P=0.602)， and DCA indicated a clinical net benefit. Compared with the TyG-only and AIP-only models， the continuous NRI values of the combined model were 0.495 and 0.364， respectively (both P<0.05)， and the corresponding IDI improvements were 0.065 and 0.021， respectively (both P<0.05). Conclusion The model combining AIP and the TyG index has certain value for identifying MCI in older patients with T2DM and may provide a reference for initial outpatient screening and further cognitive assessment.
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基本信息:
中图分类号:R587.2;R749.1
引用信息:
[1]丁科科,刘玉林,梁冰,等.AIP、TyG指数对老年2型糖尿病患者合并轻度认知功能障碍的预测效能[J].山东医药().
基金信息:
安徽省临床医学研究转化专项项目（202204295107020049）
2026-08-31
2026-08-31
2026-08-31