文献类型：期刊文献

中文题名：肥胖对2型糖尿病患者心血管自主神经功能影响的研究

英文题名：Effect of obesity-related indexes on cardiovascular autonomic nervous function in type 2 diabetes mellitus patients

作者：马红梅[1];武振亚[1];王丽娟[1];刘胜男[1];李凡凡[1];李京娟[1];杨睿斐[2];刘媛媛[2];郭茜[2];王金羊[2]

第一作者：马红梅

机构：[1]甘肃中医药大学第一临床医学院,兰州730000;[2]甘肃省人民医院内分泌科干部病区

第一机构：甘肃中医药大学临床医学院

年份：2025

卷号：33

期号：3

起止页码：161

中文期刊名：中国糖尿病杂志

外文期刊名：Chinese Journal of Diabetes

收录：;北大核心:【北大核心2023】；

基金：国家自然科学基金(81760147、81560143、82360163);甘肃省自然科学基金(21JR1RA013)。

语种：中文

中文关键词：肥胖;糖尿病;2型;心血管自主神经功能;心率变异性

外文关键词：Obesity;Diabetes mellitus,type 2:Cardiovascular autonomic nervous function;Heart rate variability

摘要：目的 探讨肥胖的相关指标变化对T2DM患者心血管自主神经功能的影响。方法 选取2020年10月至2023年10月于甘肃省人民医院内分泌科治疗的T2DM患者421例,根据内脏脂肪面积(VFA)分为<100 cm^(2)的单纯T2DM组(n=193)和≥100 cm^(2)的合并肥胖组(OB,n=228),计算BMI、腰高比(WHt R)、WHR、脂质蓄积指数(LAP)、内脏脂肪指数(VAI)、中国人内脏脂肪指数(CVAI)、锥度指数(CI)、体型指数(ABSI)、身体圆度指数(BRI),记录患者24 h动态心电图心率变异性(HRV)中时域指标,包括正常窦性RR间期总体标准差(SDNN),窦性RR间期均值标准差(SDANN),正常连续窦性RR间期差值均方根(RMSSD),相邻RR间期差值>50 ms占间期总数的百分比(PNN50),HRV三角指数,全程相邻NN间期长度之差的标准差(SDSD)。结果 与T2DM组比较,OB组年龄、体重、BMI、WC、臀围(HC)、颈围(NC)、SBP、Hb A_(1)c、TG、SUA、CI、WHt R、WHR、VFA、SFA、VAI、LAP、CVAI及BRI升高(P<0.05或P<0.01),HDL_(1)C降低(P<0.05)。OB组SDNN、SDANN、SDSD、RMSSD、HRV三角指数、PNN50低于T2DM组(P<0.05或P<0.01)。Spearman相关分析显示,SDNN、HRV三角指数与年龄、DM病程、HR、SBP、PWV、WHt R、TG、SUA、VAI、LAP、BRI、VFA、LAP、CVAI呈负相关(P<0.05或P<0.01)。Logistic回归分析显示,年龄、VFA、LAP是心脏自主神经功能障碍的影响因素。受试者工作特征曲线分析显示,VFA、年龄、LAP预测心血管自主神经功能障碍的曲线下面积为0.680、0.614、0.577,敏感度为87.5%、41.7%、61.8%,特异度为47.3%、73.6%、55.6%。结论 BMI、HC、NC、WC、TG、SFA、CI、WHt R、WHR、LAP、BRI、VAI、CVAI、VFA与T2DM患者心血管自主神经功能密切相关。随着VFA、年龄、LAP增加,心血管自主神经功能障碍风险升高。
Objective To investigate the effects of obesity related indexes on cardiovascular autonomic nervous function in type 2 diabetes mellitus(T2DM)patients.Methods A total of 421 T2DM patients treated in the Department of Endocrinology of Gansu Provincial People's Hospital were enrolled in this study from October 2020 to October 2023.All the patients were divided into simple T2DM group with VFA<100 cm^(2)(n=193)and obese group with VFA≥100 cm^(2)(OB,n=228)according to visceral fat area(VFA).BMI,waist-to-height ratio(WHtR),waist-to-hip ratio(WHR),lipid accumulation index(LAP),visceral fat index(VAI),Chinese visceral fat index(CVAI),tapeness index(CI),body shape index(ABSI),and body roundness index(BRI)were calculated.Time domain parameters of heart rate variability(HRV)in 24 h holter electrocardiogram were recorded,including the global standard deviation(SDNN)of normal sinus RR interval,standard deviation of mean value of sinus RR interval(SDANN),root mean square difference(RMSSD)of normal continuous sinus RR interval.The percentage of adjacent RR interval difference>50 ms in total interval(PNN50),the HRV triangle index,the standard deviation of the difference of the entire adjacent NN interval length(SDSD).Results Compared with T2DM group,the OB group showed an increase in age,weight,BMI,WC,hip circumference(HC),neck circumference(NC),SBP,HbA_(1)c,TG,SUA,CI,WHtR,WHR,VFA,SFA,VAI,LAP,CVAI,and BRI(P<0.05 or P<0.01),while a decrease in HDL-C(P<0.05).The SDNN,SDANN,SDSD,RMSSD,HRV trigonometric index,and PNN50 were lower in OB group than in T2DM group(P<0.05 or P<0.01).Spearman correlation analysis showed that SDNN and HRV trigonometric index was negatively correlated with age,DM duration,HR,SBP,PWV,WHtR,TG,SUA,VAI,LAP,BRI,VFA,LAP,and CVAI(P<0.05 or P<0.O1).Logistic regression analysis shows that age,VFA,and LAP are influencing factors for cardiac autonomic dysfunction.The analysis of the working characteristic curve of the subjects showed that the area under the curve of VFA,age,and LAP in predicting cardiovascular autonomic dysfunction was O.680,0.614,and 0.577,with sensitivity of 87.5%,41.7%,and 61.8%,and specificity of 47.3%,73.6%,and 55.6%respectively.Conclusions BMI,HC,NC,WC,TG,SFA,CI,WHtR,WHR,LAP,BRI,VAI,CVAI and VFA are closely related to cardiovascular autonomic nervous function in T2DM patients.As VFA,Ageand LAP increase,the risk of cardiovascular autonomic dysfunction increases.