2型糖尿病患者胰岛素敏感性与心率校正QT间期的关系。
The relationship between insulin sensitivity and heart rate-corrected QT interval in patients with type 2 diabetes.
作者信息
Yang Xiao-Hua, Su Jian-Bin, Zhang Xiu-Lin, Zhao Li-Hua, Xu Feng, Wang Xue-Qin, Cheng Xing-Bo
机构信息
Department of Endocrinology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006 China.
Department of Endocrinology, The Affiliated Haian Hospital of Nantong University, No. 17 Middle Zhongba Road, Haian, 226600 China.
出版信息
Diabetol Metab Syndr. 2017 Sep 11;9:69. doi: 10.1186/s13098-017-0268-3. eCollection 2017.
BACKGROUND
Reduced insulin sensitivity not only contributes to the pathogenesis of type 2 diabetes but is also linked to multiple metabolic risk factors and cardiovascular diseases (CVD). A prolonged heart rate-corrected QT interval (QTc interval) is related to ventricular arrhythmias and CVD mortality and exhibits a high prevalence among type 2 diabetes patients. The aim of the study was to investigate the relationship between insulin sensitivity and the QTc interval in patients with type 2 diabetes.
METHODS
This cross-sectional observational study recruited 2927 patients with type 2 diabetes who visited the Affiliated Haian Hospital and Second Affiliated Hospital of Nantong University. The insulin sensitivity index (Matsuda index, ISI) derived from 75-g OGTT and other metabolic risk factors were examined in all patients. The QTc interval was estimated using a resting 12-lead electrocardiogram, and an interval longer than 440 ms was considered abnormally prolonged.
RESULTS
The QTc interval was significantly and negatively correlated with the ISI ( = -0.296, < 0.001), and when the multiple linear regression analysis was adjusted for anthropometric parameters, metabolic risk factors, and current antidiabetic treatments, the QTc interval remained significantly correlated with the ISI ( = -0.23, = -12.63 < 0.001). The proportion of patients with prolonged QTc interval significantly increased from 12.1% to 17.9%, 25.6% and 37.9% from the fourth to third, second and first quartile of the ISI, respectively. After adjusting for anthropometric parameters by multiple logistic regression analysis, the corresponding odd ratios (ORs) for prolonged QTc interval of the first, second and third quartiles versus the fourth quartile of ISI were 3.11 (95% CI 2.23-4.34), 2.09 (1.51-2.88) and 1.53 (1.09-2.14), respectively, and for trend was <0.001.
CONCLUSIONS
Reduced insulin sensitivity is associated with an increase in the QTc interval in patients with type 2 diabetes.
背景
胰岛素敏感性降低不仅会导致2型糖尿病的发病，还与多种代谢风险因素和心血管疾病（CVD）有关。心率校正后的QT间期（QTc间期）延长与室性心律失常和CVD死亡率相关，且在2型糖尿病患者中具有较高的患病率。本研究旨在探讨2型糖尿病患者胰岛素敏感性与QTc间期之间的关系。
方法
这项横断面观察性研究招募了2927名就诊于南通大学附属海安医院和第二附属医院的2型糖尿病患者。对所有患者进行了基于75克口服葡萄糖耐量试验（OGTT）得出的胰岛素敏感性指数（松田指数，ISI）及其他代谢风险因素的检测。使用静息12导联心电图估算QTc间期，QTc间期超过440毫秒被认为是异常延长。
结果
QTc间期与ISI呈显著负相关（r = -0.296，P < 0.001），在对人体测量参数、代谢风险因素和当前抗糖尿病治疗进行多重线性回归分析调整后，QTc间期仍与ISI显著相关（r = -0.23，β = -12.63，P < 0.001）。QTc间期延长患者的比例从ISI第四四分位数的12.1%分别显著增至第三、第二和第一四分位数的17.9%、25.6%和37.9%。通过多重逻辑回归分析对人体测量参数进行调整后，ISI第一、第二和第三四分位数相对于第四四分位数的QTc间期延长的相应比值比（OR）分别为3.11（95%可信区间2.23 - 4.34）、2.09（1.51 - 2.88）和1.53（1.09 - 2.14），趋势P < 0.001。
结论
胰岛素敏感性降低与2型糖尿病患者QTc间期增加有关。
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