中老年2型糖尿病患者的血清尿酸水平与左心室舒张功能不全的关系研究

Relationship between serum uric acid level and left ventricular diastolic dysfunction in middle-aged and elderly patients with type 2 diabetes

目的探讨中老年2型糖尿病(T2DM)患者血清尿酸(SUA)水平与左心室舒张功能不全(LVDD)的关系,以及这种关系在性别之间是否存在差异。方法选取2019年1月至2020年9月在上海交通大学附属第六人民医院南院内分泌代谢科住院的40~89岁T2DM患者365例,根据SUA四分位数水平分为G1组(SUA<270μmol/L,92例)、G2组(270μmol/L≤SUA<342μmol/L,91例)、G3组(342μmol/L≤SUA<408μmol/L,90例)和G4组(SUA≥408μmol/L,92例)。比较4组基线资料和超声心电图指标,Pearson相关分析SUA与超声指标的相关性,多因素logistic回归分析不同性别SUA与LVDD的关系,绘制受试者工作特征(ROC)曲线评价SUA和多因素logistic回归模型Logit(P)诊断LVDD的效能。结果4组超声指标比较显示,左心房内径(LAD)、二尖瓣口舒张早期血流峰值速度E峰与二尖瓣环舒张早期运动峰值速度e’峰比值(E/e’)差异有统计学意义(均为P<0.01)。Pearson相关分析显示,在男性患者中,SUA与LAD、E/e’呈正相关,与二尖瓣口舒张早期血流峰值速度E峰与二尖瓣口舒张晚期血流峰值速度A峰比值(E/A)呈负相关(均为P<0.05);在女性患者中,SUA与LAD、E/e’呈正相关(均为P<0.01),与E/A无相关性(P=0.059)。多因素logistic回归分析显示,在男性患者中,随着SUA四分位数水平递增,LVDD发生风险逐渐增加(G2组:OR=2.997;G3组:OR=3.459;G4组:OR=7.339,均为P<0.05);在女性患者中,仅SUA四分位数水平最高组发生LVDD的风险显著增加(G4组:OR=3.701,P=0.031)。ROC曲线分析显示,男性患者中SUA和Logit(P)诊断LVDD的效能(AUC=0.692和0.868);女性患者中SUA和Logit(P)诊断LVDD的效能(AUC=0.683和0.827)。结论SUA在中老年T2DM患者LVDD的发展中可能起着重要作用。本研究针对不同性别建立的多因素logistic回归模型,可为临床早期预测中老年T2DM患者发生LVDD提供参考。

Objective To investigate the relationship between serum uric acid(SUA)level and left ventricular diastolic dysfunction(LVDD)in middle-aged and elderly patients with type 2 diabetes(T2 DM),and whether this relationship differs between genders.Methods A total of 365 middle-aged and elderly hospitalized patients with T2 DM in South Hospital of the Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University were enrolled from January 2019 to September 2020.The patients were divided into four groups according to the SUA level:G1 group(SUA<270μmol/L,n=92);G2 group(270μmol/L≤SUA<342μmol/L,n=91);G3 group(342μmol/L≤SUA<408μmol/L,n=90)and G4 group(SUA≥408μmol/L,n=92).Baseline data and ultrasound indicators were compared between the four groups.Pearson correlation analysis was used for the detection of the correlation between SUA and ultrasound indicators.Multivariate logistic regression analysis was used to explore the relationship between SUA and LVDD in different genders.Receiver operating characteristic(ROC)curve was used to evaluate the efficacy of SUA and multivariate logistic regression model(Logit P)in diagnosing LVDD.Results The comparison of the four groups of ultrasound indicators showed that left atrial diameter(LAD),the ration of peak flow velocity E peak in early diastole in mitral orifice and peak flow velocity E peak in early diastole in mitral annulus(E/e’)were significantly different(both P<0.01).Pearson correlation analysis showed that in male patients,SUA was positively correlated with LAD and E/e’,while was negatively correlated with the ratio of peak mitral flow velocity E peak in early diastole to peak mitral flow velocity peak in late diastole(E/A)(all P<0.05);in female patients,SUA was positively correlated with LAD and E/e’(both P<0.01),but had no correlation with E/A(P=0.059).Multivariate logistic regression analysis showed that in male patients,as the quartile level of SUA increased,the risk of LVDD gradually increased(G2:OR=2.997;G3:OR=3.459;G4:OR=7.339;all P<0.05);Among female patients,SUA level was significantly associated with the risk of LVDD only in G4 group(OR=3.701,P=0.031).ROC results showed that the efficacy of SUA in diagnosing LVDD,both in male group(AUC=0.692 and 0.868)and female group(AUC=0.683 and 0.827).Conclusions SUA may play an important role in the development of LVDD in middle-aged and elderly patients with T2 DM.The multivariate logistic regression model in this study for different genders can provide a reference for early clinical prediction of LVDD in middle-aged and elderly patients with T2 DM.