新型简化胰岛素抵抗评价指标对T2DM患者左心室亚临床收缩功能受损的预测价值  

Comparison of the predictive value of new simplified insulin resistance assessment indexes in identifying left ventricular subclinical dysfunction in T2DM patients

作　　者：陈艳艳 李梦颖 周洁 付建芳 张颖 王奕 王铖 刘向阳 拓胜军 刘丽文 李泽平 李晓苗 Chen Yan-Yan;Li Meng-Ying;Zhou Jie;Fu Jian-Fang;Zhang Ying;Wang Yi;Wang Cheng;Liu Xiang-Yang;Ta Sheng-Jun;Liu Li-Wen;Li Ze-Ping;Li Xiao-Miao(Department of Endocrinology,the First Affiliated Hospital of Air Force Medical University,Xi′an,Shaanxi 710032,China;Department of Ultrasound,the First Affiliated Hospital of Air Force Medical University,Xi′an,Shaanxi 710032,China;Department of Medicine,Queen Mary School of Nanchang University,Nanchang,Jiangxi 330038,China)

机构地区：[1]空军军医大学第一附属医院内分泌科,陕西西安710032 [2]空军军医大学第一附属医院超声科,陕西西安710032 [3]南昌大学玛丽女王学院医学部,江西南昌330038

出　　处：《解放军医学杂志》2024年第2期137-143,共7页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金面上项目(82070839);陕西省基础研究计划重点项目(2020JZ-31)。

摘　　要：目的分析新型简化胰岛素抵抗评价指标对2型糖尿病(T2DM)患者左心室亚临床收缩功能受损的预测价值。方法收集2021年6-12月就诊于空军军医大学第一附属医院内分泌科的150例左心室射血分数(LVEF)≥50%的T2DM患者进行回顾性分析。所有患者均接受二维斑点追踪超声心动图检查,并测量左心室整体纵向应变(GLS)。将受试者根据GLS值分为左心室亚临床收缩功能正常组(GLS≥18%组,n=80)与左心室亚临床收缩功能受损组(GLS<18%组,n=70)。此外,计算体重指数(BMI)、三酰甘油/高密度脂蛋白胆固醇比值(TG/HDL-C比值)、TG-葡萄糖(TyG)指数、TyG-BMI指数(TyG-BMI)、TyG-WHR指数(TyG-WHR)、胰岛素抵抗代谢指数(METS-IR),作为新型简化胰岛素抵抗评价指标,并进行两组间比较。采用Pearson相关分析法分析简化胰岛素抵抗评价指标与GLS的相关性。采用受试者工作特征(ROC)曲线下面积(AUC)评估新型简化胰岛素抵抗评价指标对GLS<18%人群的诊断效能。基于高血压分层的二元logistics回归分析简化胰岛素抵抗评估指标与GLS<18%的独立相关性。结果150例患者年龄(54.5±13.7)岁,其中男96例(64.0%),女54例(36.0%)。与GLS≥18%组比较,GLS<18%组患者的TG/HDL-C比值、Ty G指数、Ty G-BMI、METS-IR均明显增高,差异有统计学意义(P<0.05)。Pearson相关分析显示,TG/HDL-C比值、Ty G指数、Ty G-BMI、Ty G-WHR、METS-IR均与GLS呈负相关(P<0.05)。ROC曲线分析显示,Ty G指数对评价GLS<18%具有一定的预测价值(AUC=0.678,95%CI 0.591~0.765,P<0.001)。基于高血压分层且校正混杂因素后,二元logistics回归分析显示,Ty G指数与GLS<18%独立相关(OR=3.249,95%CI 1.045~10.103,P=0.042)。结论新型简化胰岛素抵抗评价指标与T2DM患者左心室亚临床收缩功能受损密切相关。TyG指数是识别该人群左心室亚临床收缩功能受损的有效指标。Objective To investigate the predictive value of new simplified insulin resistance(IR)assessment indexes in identifying subclinical left ventricular systolic function impairment in patients with type 2 diabetes mellitus(T2DM).Methods A total of 150 T2DM patients with preserved left ventricular ejection fraction(LVEF≥50%)who were admitted to Department of Endocrinology of the First Affiliated Hospital of Air Force Medical University from June 2021 to December 2021 were retrospectively analyzed.All patients underwent two-dimensional speckle tracking echocardiography to measure left ventricular global longitudinal strain(GLS).According to GLS value,the subjects were divided into the normal group(GLS≥18%group,n=80)and the impaired group(GLS<18%group,n=70).Some new simplified IR assessment indicators were calculated and compared between the two groups,including body mass index(BMI),TG/HDL‐C ratio,triglyceride-glucose(TyG)index,TyG‐BMI index,TyG‐WHR and metabolic score for IR(METS‐IR).Correlation between the GLS and the new simplified IR assessment indexes was analyzed.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of different simplified IR assessment indexes,with the area under the curve(AUC)calculated.Furthermore,according to whether the subjects were complicated with hypertension,binary logistics regression analysis was performed to explore the independent correlation between the simplified IR assessment index and GLS<18%.Results Total 150 were included with aged(54.5±13.7)years with 96(64.0%)men and 54(36.0%)women.Compared with the GLS≥18%group,the TG/HDL‐C ratio,TyG index,TyG‐BMI,and METS‐IR of subjects in the GLS<18%group were significantly increased(P<0.05).Pearson correlation analysis showed that TG/HDL‐C ratio,TyG index,TyG‐BMI,TyG‐WHR,and METS‐IR were negatively correlated with GLS(P<0.05).ROC analysis showed that TyG index had a certain predictive value for the evaluation of GLS<18%(AUC=0.678,95%CI 0.591-0.765,P<0.001).Stratification

关 键 词：糖尿病 2型 胰岛素抵抗 三酰甘油-葡萄糖指数 左心室整体纵向应变 

分 类 号：R587.1[医药卫生—内分泌]