内脏脂肪指数、脂质蓄积指数与糖尿病心脏自主神经病变的相关性研究

吴兴初; 吴俊锋; 庞肖华; 陈夏靖

doi:10.13898/j.cnki.issn.1000-2200.2023.07.023

内脏脂肪指数、脂质蓄积指数与糖尿病心脏自主神经病变的相关性研究

Study on the correlation between visceral adiposity index, lipid accumulation index and diabetic cardiac autonomic neuropathy

摘要

摘要:
目的分析内脏脂肪指数(VAI)、脂质蓄积指数(LAP)与糖尿病心脏自主神经病变(DCAN)的相关性。
方法选取2型糖尿病病人250例，依据是否发生DCAN分为DCAN组和非DCAN组。比较2组VAI、LAP、Ewing试验参数和相关生化指标水平。2组再依据VAI、LAP四分位数水平分为4个亚组(V1~V4组，L1~L4组)，比较各组DCAN的分布情况。应用Spearman相关分析评价VAI、LAP水平与DCAN病人各项Ewing试验参数的相关性，logistic回归分析计算不同VAI、LAP水平病人DCAN的发生风险，ROC曲线分析评估各体脂指标对DCAN的预测诊断价值。
结果250例2型糖尿病病人中，发生DCAN病人158例，未发生DCAN病人92例，DCAN的发生率为63.20%。DCAN组病人年龄、糖尿病病程及腰围、体质量指数、腰身比、腰臀比、VAI、LAP、总胆固醇、三酰甘油、低密度脂蛋白胆固醇水平均明显高于非DCAN组(P < 0.01)，高密度脂蛋白胆固醇水平明显低于非DCAN组(P < 0.01)。随着VAI和LAP四分位水平的增高，DCAN病人的占比不断增大，差异均有统计学意义(P < 0.01)。logistic回归分析显示，在调整危险因素后，V4组DCAN的发生风险为约VI组的7.439倍(P < 0.05)，L4组DCAN的发生风险约为L1组的53.241倍(P < 0.01)。Spearman相关分析显示，VAI、LAP与病人Valsalva R-R比值、深呼吸心率差、立卧位心率差均呈负相关关系(P < 0.05~P < 0.01)，与立卧位收缩压差、立卧位舒张压差均呈正相关关系(P < 0.05~P < 0.01)。ROC曲线分析结果显示，男性和女性病人中，VAI、LAP对DCAN预测的曲线下面积均高于其他指标，且两者在男性病人中的预测曲线下面积高于女性(P < 0.05)。
结论DCAN的患病风险与VAI、LAP水平呈正相关关系，随着VAI、LAP水平升高，DCAN的患病风险增高，相较于其他体脂指标VAI、LAP对DCAN的预测能力更佳，且两者在男性中的预测价值更高。

Abstract:
ObjectiveTo analyze the correlation between visceral adiposity index (VAI), lipid accumulation index (LAP) and diabetic cardiac autonomic neuropathy (DCAN).
MethodsTwo hundred and fifty patients with type 2 diabetes mellitus were selected and divided into DCAN group and non-DCAN group according to whether DCAN occurred.The VAI, LAP, Ewing test parameters and related biochemical indexes were compared between the two groups.According to the quartile level of VAI and LAP, the two groups were subdivided into 4 groups (V1-V4 group, L1-L4 group), and the distribution of DCAN in each group was compared.Spearman correlation analysis was used to evaluate the correlation between VAI, LAP levels and each Ewing test parameter of DCAN patients, logistic regression analysis was used to calculate the risk of DCAN in patients with different VAI and LAP levels, and ROC curve analysis was used to evaluate the predictive diagnostic value of each body fat indicator on DCAN.
ResultsAmong the 250 patients with type 2 diabetes mellitus, 158 had DCAN and 92 did not have DCAN, and the incidence of DCAN was 63.20%.The age, duration of diabetes mellitus, waist circumference, body mass index, waist to body ratio, waist to hip ratio, VAI, LAP, total cholesterol, triacylglycerol, and low-density lipoprotein cholesterol levels of patients in the DCAN group were significantly higher than those in the non-DCAN group (P < 0.01), while the level of high-density lipoprotein cholesterol was significantly lower than that in the non-DCAN group (P < 0.01).With the increase of VAI and LAP quartiles, the proportion of DCAN patients increased continuously, and the difference of which was statistically significant (P < 0.01).Logistic regression analysis showed that after adjusting the risk factors, the risk of DCAN in the V4 group was about 7.439 times of that in the V1 group (P < 0.05), and the risk of DCAN in the L4 group was about 53.241 times of that in the L1 group (P < 0.01).Spearman correlation analysis showed that VAI and LAP were negatively correlated with Valsalva R-R ratio, heart rate difference of deep breathing, and heart rate difference in upright position (P < 0.05 to P < 0.01), and positively correlated with systolic pressure difference in upright position and diastolic pressure difference in upright position (P < 0.05 to P < 0.01).ROC curve analysis results showed that the area under the curve predicted by VAI and LAP for DCAN in male and female patients was higher than other indicators, and the area under the curve predicted by VAI and LAP in male patients was higher than that in female patients (P < 0.05).
ConclusionsThe risk of DCAN is positively correlated with VAI and LAP levels.With the increase of VAI and LAP levels, the risk of DCAN increases.Compared with other body fat indicators, VAI and LAP have better predictive ability for DCAN, and both have higher predictive value in male.

HTML全文

参考文献(27)

施引文献

资源附件(0)