2型糖尿病患者胰岛素抵抗代谢评分与心脏重构的相关性  

Association between insulin resistance metabolic score and cardiac remodeling in patients with type 2 diabetes mellitus

作　　者：曲建昌 窦京涛[2] 王安平[2] 谷伟军[2] 吕朝晖[2] 母义明[2] Qu Jianchang;Dou Jingtao;Wang Anping;Gu Weijun;Lyu Zhaohui;Mu Yiming(Department of Endocrinology,the 305 Hospital of People′s Liberation Army,Beijing 100017,China;Department of Endocrinology,the First Medical Center,Chinese People′s Liberation Army General Hospital,Beijing 100853,China)

机构地区：[1]解放军第三〇五医院内分泌科,北京100017 [2]解放军总医院第一医学中心内分泌科,北京100853

出　　处：《中华糖尿病杂志》2024年第7期755-761,共7页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：解放军第三〇五医院院内基金重点项目(Z1YNZD01)。

摘　　要：目的分析2型糖尿病(T2DM)患者胰岛素抵抗代谢评分(METS-IR)与心脏重构的相关性。方法本研究为横断面研究。回顾性选取2015年4至9月进行的REACTION研究北京分中心随访人群的数据,最终纳入2 495例T2DM患者作为研究对象。收集研究对象的身高、体重(计算体重指数)以及空腹血糖(FPG)、餐后2 h血糖(2hPG)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、γ-谷氨酰转肽酶(GGT)等生化指标,并计算METS-IR。利用彩色多普勒超声仪检测室间隔厚度(IVS)、左心房内径(LAD)、左心室舒张末期内径(LVEDD),以及是否存在舒张功能减退。将研究对象根据METS-IR的四分位数分为Q1组(METS-IR<34.93,622例),Q2组(34.93≤METS-IR<39.60,625例),Q3组(39.60≤METS-IR<44.44,624例)和Q4组(METS-IR≥44.44,624例)。采用单因素方差分析进行组间比较,采用logistic回归分析法分析METS-IR与心脏重构的关系。结果 IVS、LAD、LVEDD总体上随着METS-IR的升高而升高(P<0.001)。METS-IR为IVS增厚、LAD增宽的危险因素,Q3、Q4组人群发生IVS增厚的风险分别是Q1组的1.79倍(95%CI 1.21~2.65,P=0.004)和2.45倍(95%CI 1.58~3.80,P<0.001);Q2、Q3、Q4组人群发生LAD增宽的风险分别是Q1组人群的2.84倍(95%CI 2.11~3.82,P<0.001)、4.01倍(95%CI 2.98~5.40,P<0.001)和6.86倍(95%CI 5.03~9.36,P<0.001)。METS-IR不是LVEDD增高和舒张功能减退的影响因素(均P>0.05)。结论 METS-IR与心脏重构的出现有一定的关系,与IVS增厚及LAD增宽的关系更明显。Objective To analyze the association between metabolic score for insulin resistance(METS-IR)and cardiac remodeling in patients with type 2 diabetes mellitus(T2DM).Methods This study was a cross-sectional study that retrospectively selected the follow-up data of Beijing branch of the REACTION study conducted from April 2015 to September 2015,ultimately including a total of 2495 T2DM patients.Height and weight were collected and body mass index was calculated.Fasting plasma glucose(FPG),2-hour postprandial glucose(2hPG),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),γ-glutamyl transpeptidase(GGT)were determinded and METS-IR was calculated.Interventricular septal thickness(IVS),left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),and diastolic dysfunction were measured by color Doppler echocardiography.The participants were divided into four groups according to METS-IR quartiles:Q1 group(METS-IR<34.93,622 cases),Q2 group(34.93≤METS-IR<39.60,625 cases),Q3 group(39.60≤METS-IR<44.44,624 cases)and Q4 group(METS-IR≥44.44,624 cases).One-way analysis of variance was used for comparison between groups,and logistic regression was applied to explore the association between METI-IR and cardiac remodeling.Results IVS,LAD and LVEDD increased with higher METS-IR(P<0.001),and METS-IR was an independent risk factor for IVS thickening and LAD dilation.Compared with the Q1 group,the risk of incident IVS thickening was 1.79 times(95%CI 1.21-2.65,P=0.004)and 2.45 times(95%CI 1.58-3.80,P<0.001)in Q3 and Q4 groups,respectively.Compared with the Q1 group,the risk of incident LAD widening was 2.84 times(95%CI 2.11-3.82,P<0.001),4.01 times(95%CI 2.98-5.40,P<0.001),and 6.86 times(95%CI 5.03-9.36,P<0.001)in Q2,Q3 and Q4 groups,respectively.METS-IR was not an independent risk factor for increased LVEDD and reduced diastolic function(both P>0.05).Conclusion METS-IR is associated with cardiac remodeling,particularly IVS thickening and LAD widening.

关 键 词：糖尿病 2型 横断面研究 胰岛素抵抗代谢评分 心脏重构 影响因素 

分 类 号：R587.2[医药卫生—内分泌]