Narumi Taro, Watanabe Tetsu, Kato Shigehiko, Tamura Harutoshi, Nishiyama Satoshi, Takahashi Hiroki, Arimoto Takanori, Shishido Tetsuro, Watanabe Masafumi
Department of Internal Medicine III (Cardiology), Hamamatsu University School of Medicine Hamamatsu Japan.
Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine Yamagata Japan.
Circ Rep. 2019 May 29;1(6):255-260. doi: 10.1253/circrep.CR-19-0033.
Insulin resistance as assessed using homeostasis model assessment ratio (HOMA-R) is associated with latent myocardial damage in apparently healthy subjects in health check. Meanwhile, diabetes mellitus (DM) is an unfavorable prognostic risk factor in patients with heart failure (HF). We examined the impact of pancreatic β-cell dysfunction on clinical outcomes in HF patients without DM. This study enrolled 312 HF patients without DM. Pancreatic β-cell dysfunction was defined as HOMA-β <30%. A total of 108 patients (35%) had β-cell dysfunction. Plasma brain natriuretic peptide was higher in patients with pancreatic β-cell dysfunction compared with those without (625.2 vs. 399.0 pg/mL, P<0.001). On Kaplan-Meier analysis, a significantly higher cardiovascular events rate was observed in patients with pancreatic β-cell dysfunction (log-rank test, P=0.001), but there was no significant difference between patients with and without insulin resistance. On Cox hazard analysis, pancreatic β-cell dysfunction was independently associated with cardiovascular events after adjustment for confounding factors (HR, 1.58; 95% CI: 1.02-2.45), whereas insulin resistance was not associated with cardiovascular events. Pancreatic β-cell dysfunction, but not insulin resistance, was associated with unfavorable outcome in HF patients without DM.
使用稳态模型评估比率（HOMA-R）评估的胰岛素抵抗与健康检查中表面健康的受试者的潜在心肌损伤相关。同时，糖尿病（DM）是心力衰竭（HF）患者不良的预后风险因素。我们研究了胰腺β细胞功能障碍对无DM的HF患者临床结局的影响。本研究纳入了312例无DM的HF患者。胰腺β细胞功能障碍定义为HOMA-β<30%。共有108例患者（35%）存在β细胞功能障碍。与无胰腺β细胞功能障碍的患者相比，有该功能障碍的患者血浆脑钠肽水平更高（625.2对399.0 pg/mL，P<0.001）。在Kaplan-Meier分析中，胰腺β细胞功能障碍患者的心血管事件发生率显著更高（对数秩检验，P=0.001），但有和无胰岛素抵抗的患者之间无显著差异。在Cox风险分析中，调整混杂因素后，胰腺β细胞功能障碍与心血管事件独立相关（HR，1.58；95%CI：1.02-2.45），而胰岛素抵抗与心血管事件无关。在无DM的HF患者中，胰腺β细胞功能障碍而非胰岛素抵抗与不良结局相关。
