复合膳食抗氧化指数与慢性鼻窦炎疾病负担之间的关联：胰岛素抵抗的潜在中介作用

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中文摘要

背景： 慢性鼻窦炎（CRS）是一种异质性炎性鼻窦疾病，其影像学表现和症状负担存在差异。膳食抗氧化能力和胰岛素抵抗可能与CRS疾病负担相关，但它们之间的相互关系仍不清楚。本研究探讨了能量校正的复合膳食抗氧化指数（CDAI）与CRS疾病负担之间的关联，并探索了胰岛素抵抗相关指标的潜在中介作用。
方法： 在这项单中心横断面研究中，我们分析了在葫芦岛市中心医院招募的340例临床诊断为CRS的成年患者的基线数据。采用24小时膳食回顾评估膳食摄入，并通过将六种能量校正抗氧化营养素的标准化值相加计算CDAI。CDAI按CDAI评分三分位数以及每增加1个标准差（1-SD）的标准化CDAI进行分析。HOMA-IR被指定为主要中介变量，甘油三酯-葡萄糖（TyG）指数被视为实用的非胰岛素中介变量。主要结局为Lund-Mackay CT评分，次要结局为SNOT-22评分。进行了多变量回归、二分类敏感性分析、探索性中介分析和亚组分析。
结果： 较高的CDAI三分位数与较低的空腹胰岛素、HOMA-IR、TyG指数和Lund-Mackay CT评分相关。在完全校正模型中，CDAI每增加1个标准差与较低的Lund-Mackay CT评分相关（β，-0.799；95% CI，-1.069至-0.528；p < 0.001），并与较低的SNOT-22评分相关（β，-0.979；95% CI，-1.866至-0.093；p = 0.031）。在探索性中介分析中，HOMA-IR解释了CDAI与Lund-Mackay CT评分之间关联的一部分，间接效应为-0.203，中介比例为25.4%。TyG显示出较小的间接成分，间接效应为-0.115，中介比例为14.4%。敏感性和亚组分析显示结果方向一致。
结论： 在成年CRS患者中，较高的CDAI与较低的影像学CRS疾病负担以及适度较低的症状负担相关。探索性中介分析提示，胰岛素抵抗可能部分解释了CDAI与影像学疾病负担之间的关联，而TyG作为实用的非胰岛素替代指标提供了支持性证据。这些横断面发现突出了CRS中潜在的饮食-代谢关系，并支持进一步开展前瞻性和干预性研究，以阐明时间顺序、因果关系和生物学意义。

英文摘要

BACKGROUND: Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory sinonasal disease with variable radiologic and symptom burden. Dietary antioxidant capacity and insulin resistance may be related to CRS burden, but their interrelationship remains unclear. This study investigated the association of energy-adjusted composite dietary antioxidant index (CDAI) with CRS burden and explored the potential mediating roles of insulin resistance-related indicators.
METHODS: In this single-center cross-sectional study, we analyzed baseline data from 340 adult patients with clinically diagnosed CRS who were recruited at Huludao Central Hospital. Dietary intake was assessed using 24-h dietary recalls, and the CDAI was calculated by summing standardized values of six energy-adjusted antioxidant nutrients. CDAI was analyzed as tertiles of the CDAI score and as standardized CDAI per 1-SD increment. HOMA-IR was specified as the primary mediator, and the triglyceride-glucose (TyG) index was considered a pragmatic non-insulin mediator. The primary outcome was Lund-Mackay CT score, and the secondary outcome was SNOT-22 score. Multivariable regression, binary sensitivity analyses, exploratory mediation analyses, and subgroup analyses were performed.
RESULTS: Higher CDAI tertiles were associated with lower fasting insulin, HOMA-IR, TyG index, and Lund-Mackay CT score. In fully adjusted models, each 1-SD increment in CDAI was associated with lower Lund-Mackay CT score (β, -0.799; 95% CI, -1.069 to -0.528; p < 0.001) and lower SNOT-22 score (β, -0.979; 95% CI, -1.866 to -0.093; p = 0.031). In exploratory mediation analyses, HOMA-IR accounted for part of the association between CDAI and Lund-Mackay CT score, with an indirect effect of -0.203 and a mediated proportion of 25.4%. TyG showed a smaller indirect component, with an indirect effect of -0.115 and a proportion mediated of 14.4%. Sensitivity and subgroup analyses showed directionally consistent findings.
CONCLUSION: Higher CDAI was associated with lower radiologic CRS burden and modestly lower symptom burden among adults with CRS. Exploratory mediation analyses suggested that insulin resistance may partly account for the association between CDAI and radiologic disease burden, with TyG providing supportive evidence as a pragmatic non-insulin surrogate. These cross-sectional findings highlight a potential diet-metabolism relationship in CRS and support further prospective and interventional studies to clarify temporality, causality, and biological significance.