2型糖尿病合并代谢相关性脂肪肝患者体力活动水平与心肺功能及心血管风险的关系研究

Physical activity level and cardiorespiratory fitness in patients with type 2 diabetes mellitus and metabolically associated fatty liver disease and cardiovascular risk

目的探讨2型糖尿病(T2DM)合并代谢相关性脂肪肝(MAFLD)患者体力活动水平(PA)和心肺适能(CRF)对心血管风险评分的影响,以期为改善此类患者心血管疾病预后提供理论基础。方法选取228例T2DM合并MAFLD患者,分为低PA组及中高PA组,比较两组患者临床及生化指标、能量代谢指标、运动心肺指标及心血管疾病风险的差别,并通过相关及回归分析探讨除传统心血管疾病风险预测因素外,PA、CRF及其他因素对此类患者心血管疾病风险的影响。结果低PA组10年心血管疾病风险明显高于中高PA组,而最大摄氧量(VO_(2max))、无氧阈明显低于中高PA组,差异有统计学意义(P均<0.05),10年心血管疾病风险与PA及VO_(2max)呈明显相关性,线性回归分析显示PA及7项广泛焦虑障碍量表(GAD7)是影响VO_(2max)的独立相关因素,而第1秒最大呼气容积(FEV1)、分钟最大通气量(MVV)及VO_(2max)是影响10年心血管疾病风险的独立相关因素。结论体力活动的减少及心肺功能的下降是增加T2DM合并MAFLD患者心血管风险的重要影响因素。

ObjectiveThis study explores the effects of physical activity level(PA)and cardiopulmonary fitness(CRF)on the cardiovascular risk score in patients with type 2 diabetes mellitus(T2DM)combined with metabolic-associated fatty liver disease(MAFLD),in order to provide a theoretical basis for improving the cardiovascular prognosis of such patients.Methods228 patients with T2DM combined with MAFLD were selected and divided into low PA group and moderate/high PA group.The differences in clinical and biochemical indicators,energy metabolism indicators,exercise cardiopulmonary indicators,and cardiovascular risk were compared.And through correlation and regression analysis,the effects of PA,CRF,and other factors on the cardiovascular risk of these patients except for traditional cardiovascular risk predictors were explored.ResultsThe 10-year cardiovascular risk in the low PA group was significantly higher than that in the moderate/high PA group,while the maximal oxygen uptake(VO_(2max))and anaerobic threshold(AT)were significantly lower than those in the moderate/high PA group,and the differences were statistically significant(P<0.05).The 10-year cardiovascular risk was significantly correlated with PA and VO_(2max).Linear regression analysis showed that PA and the 7-item Generalized Anxiety Disorder Scale(GAD7)were independent correlates of VO_(2max),while the forced expiratory volume in the first second(FEV1),the maximal minute ventilation(MVV),and VO_(2max)were independent correlates of the 10-year cardiovascular risk.ConclusionThe reduction of physical activity and the decline of cardiopulmonary function are important influencing factors for increasing the cardiovascular risk in patients with T2DM combined with MAFLD.