Архив офтальмологии Украины Том 14, №1, 2026

Актуальність. Проліферативна діабетична ретинопатія (ПДР) і швидке прогресування діабетичної ретинопатії (ДР) у пацієнтів із цукровим діабетом 2-го типу (ЦД2) потребують простих маркерів для стратифікації ризику. Індекс тригліцериди — глюкоза (TyG) є простим та надійним показником інсулінорезистентності, який вираховується на основі результатів рутинних лабораторних досліджень. Мета: визначити клінічну та прогностичну значущість індексу TyG як маркера ПДР і швидкого прогресування ДР протягом 2 років спостереження, а також встановити межове значення індексу TyG для практичної стратифікації ризику у пацієнтів із ЦД2. Матеріали та методи. У проспективному когортному дослідженні обстежено 357 пацієнтів із ЦД2 та ДР. Індекс TyG розраховували як ln[тригліцериди × глюкоза натще/2]. Асоціації з кінцевими точками аналізували бінарною логістичною регресією з корекцією на вік, тривалість ЦД2 та систолічний артеріальний тиск; порогове значення індексу TyG визначали за індексом Юдена. Результати. Індекс TyG був вищим у групі ПДР (p < 0,001) та при швидкому прогресуванні ДР (p = 0,004), а його збільшення на кожну одиницю асоціювалося з підвищенням шансів ПДР у 2,73 раза (95% CI 1,45–5,14; p = 0,002) і швидкого прогресування ДР у 1,89 раза (95% СІ 1,15–3,10; p = 0,012). Площа під кривою (AUC) становила 0,626 для ПДР і 0,589 для швидкого прогресування; оптимальний поріг індексу TyG становив 10,63 та забезпечував специфічність 82–83 %. Висновки. Індекс TyG є незалежним маркером тяжкого та швидкопрогресуючого перебігу ДР при ЦД2 і може використовуватись як прагматичний критерій rule-in у складі багатопараметричної стратифікації ризику для пріоритезації офтальмологічного нагляду.

Background. Proliferative diabetic retinopathy (PDR) and rapid progression of DR in patients with type 2 diabetes mellitus (T2DM) require simple markers for risk stratification. The triglyceride-glucose (TyG) index is a simple and reliable indicator of insulin resistance, which is calculated based on the results of routine laboratory tests. The purpose was to determine the clinical and prognostic significance of the TyG index as a marker of PDR and rapid progression of DR during 2 years of observation, as well as to establish a cut-off value of the TyG index for practical risk stratification in patients with T2DM. Materials and methods. In a prospective cohort study, 357 patients with T2DM and DR were examined. TyG index was calculated as ln[triglycerides×fasting glucose/2]. Associations with endpoints were analyzed by binary logistic regression with adjustment for age, T2DM duration, and systolic blood pressure; the threshold value of TyG was determined by the Youden index. Results. The TyG index was higher in the PDR group (p < 0.001) and in the rapidly progressing DR (p = 0.004), and its increase per unit was associated with a 2.73-fold increase in the odds of PDR (95% confidence interval (CI) 1.45–5.14; p = 0.002) and a 1.89-fold increase in the odds of rapid DR progression (95% CI 1.15–3.10; p = 0.012). The area under the curve was 0.626 for PDR and 0.589 for rapid progression; the optimal TyG threshold was 10.63 and provided a specificity of 82–83 %. Conclusions. The TyG index is an independent marker of severe and rapidly progressive PD in T2DM and can be used as a pragmatic “rule in” criterion as part of multiparametric risk stratification for prioritizing ophthalmological surveillance.

діабетична ретинопатія; цукровий діабет 2-го типу; індекс тригліцериди — глюкоза; інсулінорезистентність; стратифікація ризику

diabetic retinopathy; type 2 diabetes mellitus; triglyce­ride-glucose index; insulin resistance; risk stratification

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