血清尿酸/高密度脂蛋白胆固醇比值与2型糖尿病心脏结构和功能的相关性分析

Correlation Analysis Between Serum Uric Acid/High Density Lipoprotein Cholesterol Ratio and Cardiac Structure and Function in Type 2 Diabetes Mellitus

目的分析血尿酸/高密度脂蛋白胆固醇比值(UHR)与2型糖尿病(T2DM)心脏结构和功能的相关性。方法选取2021年10月-2022年10月在甘肃省人民医院内分泌科住院治疗的T2DM患者共408例为研究对象,按照血清尿酸/高密度脂蛋白胆固醇比值,将患者分为低UHR组(L-UHR,n=136),中UHR组(M-UHR,n=136),高UHR组(H-UHR,n=136)共三组。收集患者基本信息、实验室检查指标以及心脏超声参数。采用多因素Logistic回归分析探讨T2DM患者发生心脏舒张功能障碍的危险因素。Pearson相关性分析UHR与其他指标的相关性。绘制UHR联合其他指标预测T2DM患者发生心脏舒张功能障碍的受试者工作特征(ROC)曲线,确定最佳截断值。结果三组患者的性别、年龄、体质指数(BMI)、糖化血红蛋白(HbA1c)、内脏脂肪面积(VFA)、皮下脂肪面积(SFA)、胆固醇(TC)、甘油三脂(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、白蛋白、肌酐(Scr)、血尿酸(SUA)、UHR比较,差异有统计学意义(P<0.05);三组心脏超声参数中左室射血分数(LVEF)、舒张期室间隔厚度(IVSd)、舒张期左室后壁厚度(LVPWd)、左心房内径(LAd)、舒张期左心室内径(LVd)、二尖瓣环舒张早期与晚期血流峰值速度比值(E/A)、左心室质量(LVM)、左心室质量指数(LVMI)比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,多因素校正后,UHR[OR=1.005,95%CI(1.001,1.010)]、年龄[OR=1.070,95%CI(1.047,1.095)]、TG[OR=1.149,95%CI(1.003,1.316)]是T2DM患者发生心脏舒张功能不全的危险因素(P<0.05);Pearson相关性分析显示,UHR与VFA、SFA、Scr、IVS、LVPW、LA、LV呈正相关(P<0.05),与年龄、HbA1c、TC、LDL-C、估算肾小球滤过率(eGFR)、LVEF呈负相关(P<0.05);ROC曲线显示,UHR联合年龄、TG的最佳截断值为0.468,灵敏度为78.60%,特异度为57.60%,约登指数为0.362。左室舒张功能不全的曲线下面积(AUC)分别为UHR(0.631)、年龄(0.627)、TG(0.558)和Logistic(P)(0.714)。结论随着UHR值的升高,发生左心室舒张功能不全患者的占比逐渐升高,且UHR可以做为预测T2DM患者发生左心室舒张功能不全的指标。

Objective To analyze the correlation between serum uric acid/high-density lipoprotein cholesterol ratio(UHR)and cardiac structure and function in type 2 diabetes mellitus(T2DM).Methods A total of 408 patients with T2DM who were hospitalized in the Department of Endocrinology,Gansu Provincial People's Hospital from October 2021 to October 2022 were selected as the research objects.According to the ratio of serum uric acid/high-density lipoprotein cholesterol,the patients were divided into three groups:low UHR group(L-UHR,n=136),medium UHR group(M-UHR,n=136)and high UHR group(H-UHR,n=136).The basic information of patients,laboratory examination indicators,and cardiac ultrasound parameters were collected.Multivariate Logistic regression analysis was used to explore the risk factors of cardiac diastolic dysfunction in patients with T2DM.Pearson correlation analysis was used to analyze the correlation between UHR and other indicators.The receiver operating characteristic(ROC)curve of UHR combined with other indicators to predict cardiac diastolic dysfunction in T2DM patients was drawn to determine the optimal cut-off value.Results There were significant differences in gender,age,body mass index(BMI),glycosylated hemoglobin(HbA1c),visceral fat area(VFA),subcutaneous fat area (SFA), cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), albumin, creatinine (Scr), blood uric acid (SUA) and UHR among the three groups (P<0.05). There were significant differences in left ventricular ejection fraction (LVEF), diastolic interventricular septal thickness (IVSd), diastolic left ventricular posterior wall thickness (LVPWd), left atrial diameter (LAd), diastolic left ventricular diameter (LVd), mitral annulus early and late diastolic blood flow peak velocity ratio (E/A), left ventricular mass (LVM) and left ventricular mass index (LVMI) among cardiac ultrasound parameters (P<0.05).Multivariate Logistic regression analysis showed that after multivariate correction, UHR [OR=1.005,95%CI(1.001,1.010)], age [OR=1.070,95%CI(1.047,1.095)], TG[OR=1.149,95%CI(1.003,1.316)] were risk factors for cardiac diastolic dysfunction in T2DM patients (P<0.05). Pearson correlation analysis showed that UHR was positively correlated with VFA, SFA, Scr, IVS, LVPW, LA and LV (P<0.05), and negatively correlated with age, HbA1c, TC, LDL-C, estimated glomerular filtration rate (eGFR) and LVEF (P<0.05). ROC curve showed that the optimal cut-off value of UHR combined with age and TG was 0.468, the sensitivity was 78.6%, the specificity was 57.60%, and the Youden index was 0.362;the area under the curve (AUC) of left ventricular diastolic dysfunction was UHR (0.631), age (0.627), TG (0.558), Logistic (P) (0.714), respectively.Conclusion With the increase of UHR value, the proportion of patients with left ventricular diastolic dysfunction gradually increases, and UHR can be used as an indicator to predict left ventricular diastolic dysfunction in patients with T2DM.