估计葡萄糖处置率与冠状动脉狭窄严重程度关系的横断面研究  

Association of Estimated Glucose Disposal Rate With the Stenosis Severity of Coronary Artery Disease:A Cross-sectional Study

作　　者：吴育彬 陈志腾 吴茂雄 刘文浩[2] 陈倩 周仕熠 陈样新[2] 夏敏[1] WU Yubin;CHEN Zhiteng;WU Maoxiong;LIU Wenhao;CHEN Qian;ZHOU Shiyi;CHEN Yan-xin;XIA Min(School of Public Health,Sun Yat-sen University,Guangzhou 510080,China;Department of Cardiology,Sun Yat-sen Memorial Hospital,Guangzhou 510120,China)

机构地区：[1]中山大学公共卫生学院,广东广州510080 [2]中山大学孙逸仙纪念医院心内科,广东广州510120

出　　处：《中山大学学报（医学科学版）》2024年第1期136-145,共10页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广州市科技计划项目(202206080014)。

摘　　要：【目的】探讨估计葡萄糖处置率(eGDR)与冠心病(CAD)严重程度的关联。【方法】采用以医院为基础的横断面研究设计,纳入因疑似冠心病而接受冠状动脉造影检查的患者共1258人(平均年龄:62(53~68)岁;男性占53.9%)。按照eGDR公式计算胰岛素抵抗水平(IR):eGDR=21.158-[0.09×腰围(WC,cm)]-[3.407×高血压(hypertension,是/否)]-[0.551×糖化血红蛋白(HbA1c,%)]。根据eGDR三分位数对研究对象进行分组。冠心病的严重程度由狭窄血管的数量决定:无明显CAD组(所有冠脉狭窄均<50%,n=704),单支血管CAD组(只有一条受累的主要冠脉狭窄≥50%,n=205),多支血管CAD组(两条或两条以上受累的主要冠脉存在狭窄≥50%,n=349);以无明显CAD作参照,采用多因素logistic回归模型分析eGDR与CAD严重程度之间的关联。采用限制性立方样条分析eGDR和CAD在整个eGDR范围内的线性关联。采用亚组分析评估不同糖尿病状态下eGDR和CAD严重程度之间的关联。受试者工作特征(ROC)曲线分析eGDR对提高CAD筛查模型的价值。【结果】eGDR降低与CAD严重程度的风险增加显著相关。(OR:2.79;95%CI:1.72~4.55;P<0.001)。多因素logistic回归模型中,eGDR最低分位(T1)的个体患多支血管CAD的风险是eGDR最高分位(T3)的2.79倍。(OR:2.79;95%CI:1.72~4.55;P<0.001)。限制性立方样条分析显示,eGDR与CAD以及多支血管CAD之间存在负线性关联(P-linearity<0.05)。在非糖尿病患者中,与参照组(T3)相比,T1组患CAD和多支血管CAD的风险显著增加,OR分别为1.42(95%CI:1.00~2.01;P<0.05)和1.86(95%CI:1.21~2.86;P<0.05)。而在糖尿病患者中未发现此关联有统计学意义(P>0.05)。ROC曲线分析,eGDR加入到CAD传统筛查模型中时,AUC、IDI、NRI的结果显示,模型对CAD和多支血管CAD的筛查有显著改善。【结论】eGDR与CAD及CAD严重程度呈负相关。eGDR作为一种无创且易于获取的非胰岛素测量指标,具有筛查大规模人群中CAD严重程度的潜在价【Objective】To investigate the association between estimated glucose disposal rate(eGDR)and the severity of coronary heart disease.【Methods】We conducted a hospital-based cross-sectional study that included 1258 patients(mean age:62(53-68)years)who underwent coronary angiography for suspected coronary artery disease(53.9%were male).Insulin resistance level(IR)was calculated according to eGDR formula:eGDR=21.158-(0.09×WC)-(3.407×hypertension)-(0.551×HbA1c)[hypertension(yes=1/no=0),HbA1c=HbA1c(%)].Subjects were grouped according to the eGDR quantile.CAD severity was determined by the number of narrowed vessels:no-obstructive CAD group(all coronary stenosis were<50%,n=704),Single-vessel CAD group(only one involved major coronary artery stenosis≥50%,n=205),Multi-vessel CAD group(two or more involved major coronary arteries stenosis≥50%,n=349);Multivariate logistic regression model was used to analyze the association between eGDR and CAD severity.The linear relationship between eGDR and CAD in the whole range of eGDR was analyzed using restricted cubic spline.Subgroup analyses were used to assess the association between eGDR and CAD severity in different diabetic states.Receiver operating characteristic(ROC)curve analysis were used to evaluate the value of eGDR in improving CAD recognition.【Results】A decrease in the eGDR index was significantly associated with an increased risk of CAD severity(OR:2.79;95%CI:1.72~4.55;P<0.001).In multivariate logistic regression models,individuals with the lowest quantile of eGDR(T1)were 2.79 times more likely to develop multi-vessel CAD than those with the highest quantile of eGDR(T3)(OR:2.79;95%CI:1.72~4.55;P<0.001).Multivariate restricted cubic spline analysis showed that eGDR was negatively associated with CAD and multi-vessel CAD(P-nonlinear>0.05).In non-diabetic patients,compared with the reference group(T3),the T1 group had a significantly increased risk of CAD(OR:1.42;95%CI:1.00~2.01;P<0.05)and multi-vessel CAD(OR:1.86;95%CI:1.21~2.86;P<0.05).No statistical ass

关 键 词：冠心病 葡萄糖处置率 冠心病严重程度 多支血管病变冠心病 冠状动脉狭窄 横断面研究 

分 类 号：R181.2[医药卫生—流行病学]