Selective association of electrocardiographic abnormalities with insulin sensitivity and beta-cell function in type 2 diabetes mellitus: a cross-sectional analysis.
Selective association of electrocardiographic abnormalities with insulin sensitivity and beta-cell function in type 2 diabetes mellitus: a cross-sectional analysis.
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DOI：
10.1002/dmrr.2794
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发表时间：
2016-10
期刊：
影响因子：
--
通讯作者：
Reilly MP
中科院分区：
文献类型：
--
作者：
Bhatt AB;Mulvey CK;Qasim AN;Nair JV;Rickels MR;Prenner SB;Iqbal N;Reilly MP
我们在一项2型糖尿病患者的横断面研究中调查了心电图（ECG）异常与胰岛素抵抗和胰腺β细胞功能障碍标志物的相关性。在宾夕法尼亚糖尿病心脏研究（PDHS）参与者（n=1671; 64%男性; 61%白人）中评价ECG标准，包括接受口服葡萄糖耐量试验（OGTT）的子样本（n=710）。Matsuda胰岛素敏感性指数（MISI）和胰岛素抵抗稳态模型评估（HOMA-IR）评估胰岛素敏感性;胰岛素生成指数（IGI）和β细胞功能稳态模型评估（HOMA-B）评估β细胞功能。采用多元回归模型分析心电图改变与这些指标的关系。在未校正的分析中，MISI最高四分位数的受试者Q波患病率最低（6.3% vs. 15.3%，p = 0.005）。在调整后的模型中，Q波与log MISI之间呈负相关[标准差（SD）增加一个; OR=0.59（95% CI 0.43-0.87 p = 0.001）]。在完全PDHS中，Q波与HOMA-IR之间存在直接关联[SD增加1; OR=1.43（95% CI 1.13-1.81，p = 0.003）]。在校正模型中，左心室肥厚（LVH）与MISI呈负相关，与HOMA-IR呈正相关，IGI评分越高，非特异性ST段改变发生率越低[OR=0.78（95%CI 0.62-0.98，p = 0.032）]。在2型糖尿病患者中，OGTT和HOMA衍生的胰岛素抵抗指标均与ECG上的病理性Q波和LVH相关。
We investigated the association of electrocardiographic (ECG) abnormalities with markers of insulin resistance and pancreatic beta-cell dysfunction in a cross-sectional study of type 2 diabetic patients. ECG criteria were evaluated in the Penn Diabetes Heart Study (PDHS) participants (n=1671; 64% male; 61% Caucasian), including a sub-sample (n=710) that underwent oral glucose tolerance testing (OGTT). The Matsuda Insulin Sensitivity Index (MISI) and homeostasis model assessment of insulin resistance (HOMA-IR) estimated insulin sensitivity; Insulinogenic Index (IGI) and homeostasis model assessment of beta-cell function (HOMA-B) assessed beta-cell function. Multivariable regression modeling was used to analyze associations of ECG changes with these indices. In unadjusted analyses, subjects in the highest quartile of MISI had the lowest prevalence of Q-waves (6.3% vs. 15.3%, p = 0.005). In adjusted models, an inverse association was seen between Q-waves and log MISI [one standard-deviation (SD) increase; OR=0.59 (95% CI 0.43–0.87 p = 0.001)]. In the full PDHS, there was a direct association between Q-waves and HOMA-IR [one SD increase; OR=1.43 (95% CI 1.13–1.81, p = 0.003)]. In adjusted models, left ventricular hypertrophy (LVH) also was inversely associated with MISI and directly with HOMA-IR. Higher IGI scores were associated with a lower prevalence of nonspecific ST changes [OR=0.78 (95% CI 0.62–0.98, p = 0.032)]. In type 2 diabetic patients, both OGTT- and HOMA-derived measures of insulin resistance were associated with pathologic Q waves and LVH on ECGs.
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