Abstract:Objective To explore the level of serum triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio in patients with type 2 diabetes mellitus (T2DM) in different Fazekas score, and its correlationship with white matter hyperintensities (WMH). Methods The data of MRI were collected of 529 T2DM patients admitted to the Department of Endocrinology, Zhejiang Provincial People's Hospital from January to June 2021, and Fazekas scores were independently assessed by specialised individuals. The patients were divided into four group according to Fazekas score: grade 0 (n=210), grade 1 (n=257), grade 2 (n=48), and grade 3 (n=14). General information and laboratory results were collected for a retrospective cross-sectional study. The relationship between TG/HDL-C and Fazekas score was assessed by multivariate ordinal logistic regression, and the relationship between TG/HDL-C and the risk of WMH was fitted using restricted cubic spline plots. Results Of the 529 patients, 319 were WMH positive, accounting for 60.3%. Differences in gender, age, systolic blood pressure, diastolic blood pressure, duration of diabetes, fasting blood glucose, albumin and history of hypertension were statistically significant between the four groups of grade 0, 1, 2 and 3 (P＜0.05). There was no significant difference in TG/HDL-C［M（IQR）］ among the four groups [1.4(1.8) vs 1.4(1.6) vs 1.3(1.1) vs 1.6(1.6), H=5.361, P=0.147]. Multivariate ordinal logistic regression analysis showed that TG/HDL-C was independently associated with Fazekas score (OR= 1.119, 95%CI: 1.031-1.214, P=0.007). Adjusted multivariate restricted cube splines showed that there was a dose-response relationship between TG/HDL-C and the risk of WMH. When TG/HDL-C＞1.385, the risk of WMH was increased significantly. Conclusion TG/HDL-C levels are independently associated with the risk and severity of WMH in patients with T2DM.