摘要
目的探讨胰岛素抵抗(insulin resistance,IR)对非糖尿病射血分数保留性心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者的影响。方法选取2022年1月至2024年1月河北北方学院心血管内科住院的400例非糖尿病慢性HFpEF患者为研究对象。根据纳入标准及排除标准筛选后最终根据IR指数(homeostatic model assessment of insulin resistance,HOMA-IR)进行分组:HOMA-IR≥2.5为IR组(n=120),HOMAIR<2.5为非IR组(n=120)。收集患者的临床资料,包括病史记录、超声心动图检查结果、实验室检查结果等,并进行详细评估。结果(1)一般资料:两组患者年龄、身高、吸烟史、饮酒史、原发性高血压(高血压)、冠状动脉粥样硬化性心脏病(冠心病)等比较,差异无统计学意义(P>0.05);IR组女性、纽约心脏协会(New York Heart Association,NYHA)心功能IV级、心房颤动(atrial fibrillation,AF)患者比例及体质量指数(body mass index,BMI)显著高于非IR组,差异有统计学意义(P<0.05)。(2)临床和实验室指标:IR组患者的空腹胰岛素(fasting insulin,FINS)、空腹血糖(fasting blood glucose,FBG)、N末端B型脑钠肽前体(N-terminal pro-B-type natriuretic peptide,NT-proBNP)、胰岛素自身抗体(insulin autoantibodies,IAA)、三酰甘油-血糖(triglyceride-glucose,TyG)指数、尿酸(uric acid,UA)均显著高于非IR组,差异有统计学意义(P<0.05);IR组患者的左心室舒张末期直径(left ventricular end-diastolic diameter,LVEDD)和左心室收缩末期直径(left ventricular end-systolic diameter,LVESD)显著高于非IR组,差异有统计学意义(P<0.05)。(3)相关性分析:Spearman相关性分析结果显示BMI、FINS、FBG、NT-proBNP、IAA、AF、TyG指数、UA、LVEDD和LVESD均与IR呈正相关,且均有统计学意义(P<0.05)。(4)相关影响因素回归分析:Logistic二元回归分析结果表明BMI、NT-proBNP、IAA、FINS、AF、TyG指数均是IR发生的独立危险因素(OR>1),其中,TyG指数OR值最大。结论IR与HFpEF存在显著关联;BMI、FINS、FBG、NT-proBNP、IAA、AF、TyG指数、UA、LVEDD和LVESD均与IR呈正相关,且BMI、NT-proBNP、IAA、FINS、AF和TyG指数被确定为IR的独立危险因素,其中TyG指数的风险预测能力最强。IR可能在HFpEF的发展中扮演重要角色,同时相关的临床和实验室指标对IR的风险评估具有重要意义。
Objectives To investigate the impact of insulin resistance(IR)in patients with non-diabetic heart failure with preserved ejection fraction(HFpEF).Methods A total of 400 non-diabetic chronic HFpEF patients hospitalized in The First Affiliated Hospital of Hebei North University between January 2022 and January 2024 were enrolled.After screening based on inclusion and exclusion criteria,the patients were divided into two groups according to the homeostatic model assessment of insulin resistance(HOMA-IR):IR group(HOMA-IR≥2.5,n=120)and non-IR group(HOMA-IR<2.5,n=120).Clinical data,including medical history,echocardiography and laboratory tests,were collected and analyzed.Results(1)Baseline characteristics:No significant differences were observed in age,height,smoking history,alcohol consumption,hypertension or coronary artery disease between the two groups(P>0.05).However,IR group had a significantly higher proportion of females,prevalences of New York Heart Association(NYHA)heart functionⅣ,atrial fibrillation and body mass index(BMI)compared to non-IR group(P<0.05).(2)Clinical and laboratory parameters:Concentrations of fasting insulin(FINS),fasting blood glucose(FBG),N-terminal pro-B-type natriuretic peptide(NT-proBNP),insulin autoantibodies(IAA),triglyceride-glucose(TyG)index and uric acid(UA)were significantly higher in IR group than in non-IR group(P<0.05).Echocardiographic measurements revealed that left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)were also significantly elevated in IR group than in non-IR group(P<0.05).(3)Correlation analysis:Spearman correlation analysis demonstrated that BMI,FINS,FBG,NT-proBNP,IAA,atrial fibrillation,TyG index,UA,LVEDD and LVESD were positively correlated with IR(all P<0.05).(4)Multivariate regression analysis:Binary Logistic regression identified that BMI,NTproBNP,IAA,FINS,atrial fibrillation and TyG index as independent risk factors for HFpEF(OR>1),with the TyG index exhibiting the highest OR value.Conclusions There is a significant association between IR and HFpEF.BMI,FINS,FBG,NT-proBNP,IAA,atrial fibrillation,TyG index,UA,LVEDD,and LVESD all show a positive correlation with IR.Among these,BMI,NT-proBNP,IAA,FINS,atrial fibrillation,and the TyG index were identified as independent risk factors for IR,with the TyG index demonstrating the strongest risk-predictive capability.IR may play a crucial role in the development of HFpEF,while relevant clinical and laboratory indicators are of significant importance for IR risk assessment.
作者
张爱爱
杜美玲
刘纬
易梦阳
张泽鹏
师玥
鲁濛
杨淼
李方江
ZHANG Aiai;DU Meiling;LIU Wei;YI Mengyang;ZHANG Zepeng;SHI Yue;LU Meng;YANG Miao;LI Fangjiang(Department of Cardiology,The First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;Emergency Department,The First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;Hebei North University,Zhangjiakou 075000,China)
出处
《岭南心血管病杂志》
2025年第5期499-504,共6页
South China Journal of Cardiovascular Diseases
基金
张家口市2023年市科技计划自筹经费项目(项目编号:2322071D)。
关键词
心力衰竭
胰岛素抵抗
非糖尿病
影响
heart failure
insulin resistance
non-diabetic
clinical characteristics
