恰加斯病心肌受累与胰岛素抵抗：一种非代谢性心肌病模型。
Myocardial Involvement in Chagas Disease and Insulin Resistance: A Non-Metabolic Model of Cardiomyopathy.
机构信息
Public Health and Epidemiological Studies Group, Cardiovascular Foundation of Colombia, Floridablanca, CO.
Heart Failure and Heart Transplant Clinic, Fundación Cardiovascular de Colombia, Floridablanca, Santander, CO.
出版信息
Glob Heart. 2020 Apr 24;15(1):36. doi: 10.5334/gh.793.
BACKGROUND
Heart failure (HF) and type 2 Diabetes Mellitus (T2DM) represent two chronic interrelated conditions accounting for significant morbidity and mortality worldwide. Insulin resistance (IR) has been identified as a risk factor for HF; however, the risk of IR that HF confers has not been well elucidated. The present study aims to analyze the association between myocardial involvement in Chronic Chagas Cardiomyopathy (CCM) and IR, taking advantage of this non-metabolic model of the disease.
METHODS
Cross-sectional study performed during the period 2015-2016. Adults with a serological diagnosis of Chagas disease were included, being divided into two groups: CCM and non-CCM. IR was determined by HOMA-IR index. Bivariate analysis and multivariate logistic regression were performed to determine the association between IR as an outcome and CCM as primary exposure.
RESULTS
200 patients were included in the study, with a mean age of 54.7 years and a female predominance (53.5%). Seventy-four (37.0%) patients were found to have IR, with a median HOMA-IR index of 3.9 (Q1 = 3.1; Q3 = 5.1). Multiple metabolic variables were significantly associated with IR. In a model analyzing only individuals with an altered HWI, an evident association between CCM and IR was observed (OR 4.08; 95% CI 1.55-10.73, p = 0.004).
CONCLUSION
CCM was significantly associated with IR in patients with an altered HWI. The presence of this association in a non-metabolic model of HF (in which the myocardial involvement is expected to be mediated mostly by the parasitic infection) may support the evidence of a direct unidirectional correlation between this last and IR.
背景
心力衰竭（HF）和 2 型糖尿病（T2DM）是两种相互关联的慢性疾病，在全球范围内导致了大量的发病率和死亡率。胰岛素抵抗（IR）已被确定为 HF 的危险因素；然而，HF 赋予的 IR 风险尚未得到充分阐明。本研究旨在利用该疾病的非代谢模型，分析慢性恰加斯心肌病（CCM）患者心肌受累与 IR 之间的关联。
方法
2015 年至 2016 年期间进行的横断面研究。纳入了血清学诊断为恰加斯病的成年人，并将其分为 CCM 组和非 CCM 组。通过 HOMA-IR 指数确定 IR。进行了双变量分析和多变量逻辑回归，以确定 IR 作为结果与 CCM 作为主要暴露之间的关联。
结果
共纳入 200 名患者，平均年龄为 54.7 岁，女性居多（53.5%）。74 名（37.0%）患者存在 IR，HOMA-IR 指数中位数为 3.9（Q1 = 3.1；Q3 = 5.1）。多项代谢变量与 IR 显著相关。在仅分析 HWI 改变个体的模型中，CCM 与 IR 之间存在明显关联（OR 4.08；95%CI 1.55-10.73，p = 0.004）。
结论
在 HWI 改变的患者中，CCM 与 IR 显著相关。在 HF 的非代谢模型中（预期心肌受累主要由寄生虫感染介导），这种关联的存在可能支持 HF 与 IR 之间存在直接单向相关性的证据。
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