肥胖评价指标对2型糖尿病患者心脏结构和功能影响的研究  

Effects of obesity measures on cardiac structure and function in patients with type 2 diabetes mellitus

作　　者：牛璐 贺枫 雒杲 杨睿斐 李凡凡 李京娟 成晓琼 安斌斌 刘媛媛 郭茜[2] 王金羊[2] NIU Lu;HE Feng;LUO Gao(The First Clinical Medical College of Gansu University of Chinese Medicine,Lanzhou 730000,China)

机构地区：[1]甘肃中医药大学第一临床医学院,兰州730000 [2]甘肃省人民医院内分泌科

出　　处：《中国糖尿病杂志》2022年第12期881-886,共6页Chinese Journal of Diabetes

基　　金：国家自然科学基金(81760147、81560143);国家重点研发计划项目(SQ2018YFC130078);甘肃省自然科学基金(21JR1RA013)。

摘　　要：目的 探讨肥胖评价指标对T2DM患者心脏结构和功能的影响。方法 选取2020年10月至2021年10月于甘肃省人民医院内分泌科治疗的T2DM患者234例,采用生物电阻抗法检测内脏脂肪面积(VFA),分为VFA<100 cm2的非肥胖糖尿病组(Con,n=113)和VFA≥100 cm2的肥胖糖尿病组(OB,n=121),计算BMI、腰高比(WHtR)、脂质蓄积指数(LAP)、内脏脂肪指数(VAI)、中国人内脏脂肪指数(CVAI)。彩色多普勒超声心动图记录左室射血分数、左室短轴速率、舒张末期左室内径(LVDd)、舒张末期室间隔厚度(IVSd)、舒张末期左室后壁厚度(LVPWd)、计算左心室质量(LVM)、左心室质量指数(LVMI)及二尖瓣环舒张早期与晚期血流峰值速度比值(E/A),比较两组临床资料和心脏超声参数的差异,分析肥胖评价指标对心脏结构和功能的影响及相互关系,受试者工作特征(ROC)曲线预测心脏舒张功能不全的最佳切点。结果 与Con组比较,OB组BMI、WC、WHtR、LAP、VAI、CVAI、VFA、LVPWd、IVSd、LVM、LVMI、LVDd和E/A<1的患者构成比升高(P<0.05)。相关分析显示,E/A<1和LVPWd与BMI、WC、WHtR、LAP、CVAI、VFA呈正相关(P<0.05)。Logistics回归分析显示,VFA和CVAI是左心室舒张功能不全的危险因素。ROC曲线分析显示,E/A<1的曲线下面积从大到小依次为CVAI(0.753)、年龄(0.689)、VFA(0.683),最佳预测切点为117.51、52.5岁、101.5 cm2。多元逐步回归分析显示,VFA、CVAI、SBP是LVPWd的影响因素。结论 BMI、WC、WHtR、LAP、VAI、CVAI、VFA与T2DM患者心脏结构和功能密切相关。随着VFA和CVAI增加,左心室舒张功能不全和肥厚风险升高。Objective Exploring the effects of obesity measures on cardiac structure and function in type 2 diabetic patients.MethodsA total of 234 patients with type 2 diabetes mellitus(T2DM)who admitted to the Endocrinology the Department of Endocrinology,Gansu Provincial Hospital from October2020 to October 2021 were enrolled in this study.Visceral fat area(VFA)was measured by bioelectrical impedance analysis.Then all the participants were divided into non‐obese diabetes group(group Con:VFA<100 cm~2)and obese diabetes group(group OB:VFA≥100 cm~2).Waist circumference(WC)was measured and BMI,waist height ratio(WHtR),lipid accumulation index(LAP),visceral adiposity index(VAI),and Chinese visceral adiposity index(CVAI)were calculated.Color Doppler echocardiography was used to record left ventricular ejection fraction(LVEF),left ventricular fraction shortening(LVFS),left ventricular end‐diastolic diameter(LVDd),left atrial diameter(LAD),interventricular septal dimensions(IVSd),left ventricular posterior wall dimensions(LVPWd),and then left ventricular mass(LVM),left ventricular mass index(LVMI)and E/A ratio were calculated.Clinical data and cardiac ultrasound parameters were compared between the two groups.The effects and interrelationships of obesity measures on changes in cardiac structure and function were investigated.The best cut‐off point for predicting diastolic dysfunction was evaluated by analyzing the receiver operating characteristic(ROC)for obesity measures.Results Compared with Con group,BMI,WC,WHtR,LAP,VAI,CVAI,VFA,LVPWd,IVSd,LVM,LVMI,LVDd and the proportion of patients with E/A<1 were all significantly increased in the group OB(P<0.05).But there were no significant differences in LVFE and LVFS between the two groups(P>0.05).Correlation analysis showed that BMI,WC,WHtR,LAP,CVAI,VFA were positively correlated with E/A<1 and LVPWd(P<0.05).Logistic regression analysis showed that VFA and CVAI were independent risk factors for ventricular diastolic insufficiency.ROC curve analysis showed that the area under t

关 键 词：肥胖评价指标 糖尿病 2型 心脏结构 心脏功能 

分 类 号：R587.1[医药卫生—内分泌]