基于颈动脉瞬时波强技术探讨胰岛素抵抗对PCOS患者心血管功能改变的临床研究

Clinical study on effects of insulin resistance on cardiovascular function in patients with PCOS based on carotid artery transient wave intensity technology

目的探讨胰岛素抵抗(IR)对多囊卵巢综合征(PCOS)患者外周血管弹性及左心功能影响。方法收集2021年6月至2022年12月于黑龙江中医药大学附属第二医院就诊的135例PCOS患者的临床资料,按体质量指数(BMI)将患者分为BMI正常(18.5~24 kg/m 2)组(n=76)和BMI异常(≥24 kg/m 2)组(n=59),并依据胰岛素抵抗指数(HOMA-IR),将BMI正常组和异常组分别分成NIR亚组(HOMA-IR<2.69)和IR亚组(HOMA-IR≥2.69)。所有患者均行常规及颈动脉瞬时波强技术(WI)超声技术检测,比较各组间一般参数:BMI、腰臀比(WHR);血清学参数:总睾酮(TT)、总胆固醇(TC)、甘油三脂(TG)、载脂蛋白B/载脂蛋白A1(Apo B/A1)、HOMA-IR;WI参数:僵硬度(β)、血管压力-应变弹性系数(Ep)、单点脉搏波速度(PWVβ)、顺应性(AC)、负向波面积(NA)、瞬时加速度波强峰值(W1)、瞬时减速度波强峰值(W2)、心电图R波至W1波顶点时间(R-1st)及内中膜厚度(ITM)、左心室射血分数(LVEF)、二尖瓣口舒张期E、A峰值流速比值(E/A)等指标差异。通过Pearson相关性分析WI参数与IMT、HOMA-IR、LVEF之间的相关性。结果(1)与BMI正常组比较,BMI异常的PCOS患者中IR的发生率显著升高(44.07%vs.26.32%,P<0.05)。(2)一般参数及血清学参数比较:BMI正常组中,NIR亚组和IR亚组间无显著差异(P>0.05);BMI异常组中,IR组的WHR、TC、TG、Apo B/A1及TT值均显著高于NIR组(P<0.05)。(3)常规心血管参数比较:BMI正常组中,NIR亚组和IR亚组间无显著差异(P>0.05);BMI异常组中,IR亚组的ITM值显著高于NIR亚组(0.97 vs.0.80),而E/A值显著低于NIR亚组(0.92 vs.1.24)(P<0.05)。(4)WI心血管参数比较:BMI正常组中,IR亚组β、Ep值均显著高于NIR亚组,而AC、WI值均显著低于NIR亚组(P<0.05);BMI异常组中,IR亚组β、Ep、PWVβ、NA、R-1st值均显著高于NIR亚组,而AC、WI、W2值均显著低于NIR亚组(P<0.05)。(5)相关性分析结果显示,在PCOS-IR患者中,β、Ep、AC与IMT、HOMA-IR具有显著相关性(r>0.70,P均<0.05),W1与LVEF、HOMA-IR具有显著相关性(r=0.72、-0.74,P均<0.05)。结论IR对不同BMI的PCOS患者心血管功能均有不同程度影响,WI技术能够发现亚临床症状PCOS-IR患者外周血管弹性及左心功能的改变,从而提供新的临床诊疗依据。

Objective:To explore the effects of insulin resistance(IR)on peripheral vascular elasticity and left ventricular function changes in patients with polycystic ovary syndrome(PCOS).Methods:The clinical data of 135 PCOS patients who visited our hospital from June 2021 to December 2022 were collected.The patients were divided into the normal BMI group(18.5-24 kg/m 2)(n=76)and abnormal BMI group(≥24 kg/m 2)(n=59)according to body mass index(BMI).According to the insulin resistance index(HOMA-IR),the normal and abnormal BMI groups were subdivided into NIR groups(HOMA-IR<2.69)and IR groups(HOMA-IR≥2.69),respectively.All patients were examined by conventional and carotid artery transient wave intensity technique(WI)techniques.The general parameters including BMI and waist-hip ratio(WHR),serological parameters including total testosterone(TT),total cholesterol(TC),triglycerides(TG),apolipoprotein B/apolipoprotein A1(Apo B/A1)and HOMA-IR,WI parameters including stiffness degree(β),pressure-strain elasticity modulus(Ep),pulse wave velocity(PWVβ),arteria compliance(AC),negative area(NA),accelerating wave intensity(W1),decelerating wave intensity(W2),the time between the peak of R wave to the peak of Wl(R-1st)and intima media thickness(ITM),left ventricular ejection fraction(LVEF),the ratio of E and A peak flow velocity during mitral valve diastolic period(E/A)were compared among the groups.The correlation between WI parameters and IMT,HOMA-IR and LVEF were analyzed by Pearson’s correlation.Results:Compared with PCOS patients with normal BMI,the incidence of IR was significantly higher in PCOS patients with abnormal BMI(44.07%vs.26.32%,P<0.05).In the normal BMI group,there was no significant difference in general and serological parameters between the NIR and IR subgroups(P>0.05).In the abnormal BMI group,the values of WHR,TC,TG,Apo B/A1 and TT in the IR group were significantly higher than those in the NIR group(P<0.05).There was no significant difference in conventional cardiovascular parameters between the NIR subgroup and the IR subgroup in the normal BMI group(P>0.05).In the abnormal BMI group,ITM values of the IR group were significantly higher than those in NIR group(0.97 vs.0.80),while E/A values(0.92 vs.1.24)were significantly lower than those in the NIR group(P<0.05).Comparison of WI cardiovascular parameters,βand Ep values in the IR group were significantly higher than those in the NIR group,whereas AC and WI values were significantly lower than those in the NIR group in normal BMI group(P<0.05).In the abnormal BMI group,β,Ep,PWVβ,NA and R-1st values in the IR group were significantly higher than those in the NIR group,while AC,WI and W2 values were significantly lower(P<0.05).In PCOS-IR patients,β,Ep,and AC were significantly correlated with IMT and HOMA-IR(r>0.70,all P<0.05),and W1 was significantly correlated with LVEF and HOMA-IR(r=0.72,-0.74,all P<0.05).Conclusions:IR affects cardiovascular function to varying degrees in PCOS patients with different BMI,and WI technology is able to detect changes in peripheral vascular elasticity and left ventricular function in patients with subclinical symptoms of PCOS-IR,thus providing a new basis for clinical diagnosis and treatment.