内脏脂肪面积与2型糖尿病病情进展及DPN发病风险的关联研究

Study on the relationship between visceral fat area and the progression of type 2 diabetes and the risk of DPN

目的观察内脏脂肪面积(VFA)与2型糖尿病(T2DM)病情进展及糖尿病周围神经病变(DPN)发病风险的关联。方法本研究为回顾性研究,研究对象为郑州大学附属郑州市中心医院高新区医院2022年6月至2023年6月收治的126例T2DM患者,依据胰岛素抵抗程度不同,将入组患者分别列为轻度组(日均胰岛素补充量<2.0 U,共36例)、重度组(日均胰岛素补充量为2.0~3.0 U,共45例)、极重度组(日均胰岛素补充量>3.0 U,共45例),比较三组患者VFA、血糖水平、胰岛功能指标间差异,经Spearman相关性系数检验VFA与血糖指标、胰岛功能指标间的相关性;依据是否并发DPN,将入组患者分为DPN组、非DPN组,比较两组患者VFA、血糖水平、胰岛功能指标间差异,通过绘制受试者工作特征曲线(ROC),并观察线下面积(AUC)验证VFA对T2DM并发DPN的预测效能。结果极重度组患者的VAF、空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)均高于重度组、轻度组,极重度组的胰岛素敏感系数(ISI)低于重度组、轻度组,差异具有统计学意义(P<0.05)。经Spearman相关性系数检验,VFA与T2DM患者的FBG、2 hPG、HbA1c、FINS、HOMA-IR正相关,与ISI负相关(P<0.05)。DPN组的VAF、FBG、2 hPG、HbA1c、FINS、HOMA-IR均高于非DPN组,ISI低于非DPN组,差异具有统计学意义(P<0.05)。ROC曲线表明,VFA对T2DM并发DPN有较高预测效能(AUC>0.85,P<0.05),其预测灵敏度为81.44%,特异度为75.35%,截断值为121.40 cm2。结论VFA与T2DM患者的FBG、2 hPG、HbA1c、FINS、HOMA-IR正相关,与ISI负相关,通过测量VFA能实现对T2DM患者并发DPN的早期预测。

Objective To observe the association between VFA and the progression of T2DM and the risk of DPN.Methods This study is a retrospective study,and 126 T2DM patients admitted to our hospital from June 2022 to June 2023 will be randomly selected as the study subjects.Based on the degree of insulin resistance,the enrolled patients will be divided into mild group(The average daily dose of insulin supplementation was<2.0 U in 36 cases),severe group(daily insulin supplementation of 2.0-3.0 U,a total of 45 cases),and extremely severe group(daily insulin supplementation of>3.0 U,a total of 45 cases),Compare the differences in VFA,blood glucose levels,and pancreatic function indicators among three groups of patients,and test the correlation between VFA,blood glucose indicators,and pancreatic function indicators using Spearman correlation coefficient;According to whether there is concurrent DPN,the enrolled patients are divided into DPN group and non DPN group.The differences in VFA,blood glucose levels,and pancreatic function indicators between the two groups are compared.The ROC is plotted,and the AUC is observed to verify the predictive effect of VFA on T2DM complicated with DPN.Results The VAF,fasting blood glucose(FBG),2 hPG after meal blood glucose(HbA1c),fasting insulin(FINS)and insulin resistance index(HOMA-IR)of the extremely severe group were higher than those of the severe and mild groups,and the insulin sensitivity coefficient(ISI)of the extremely severe group was lower than that of the severe and mild groups.The difference was statistically significant(P<0.05).Spearman correlation coefficient test showed that VFA was positively correlated with FBG,2 hPG,HbA1c,FINS and HOMA-IR,and negatively correlated with ISI in T2DM patients(P<0.05).VAF,FBG,2 hPG,HbA1c,FINS and HOMA-IR in DPN group were higher than those in non-DPN group,and ISI was lower than those in non-DPN group,the difference was statistically significant(P<0.05).ROC curve showed that VFA had high predictive efficacy for T2DM concurrent DPN(AUC>0.85,P<0.05),and its predictive sensitivity was 81.44%,specificity was 75.35%,and truncation value was 121.40 cm2.Conclusion VFA is positively correlated with FBG,2 hPG,HbA1c,FINS and HOMA-IR,and negatively correlated with ISI in T2DM patients.Measurement of VFA can achieve early prediction of DPN in T2DM patients.