Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine, Faculty of Medicine, Altinbas University, Bakırköy, Istanbul, Turkey.
Eur Rev Med Pharmacol Sci. 2024 Feb;28(3):1044-1051. doi: 10.26355/eurrev_202402_35340.
The female population with gestational diabetes mellitus (GDM) has a postpartum profile with increased cardiovascular (CV) risk factors and heightened prospective CV risk. Epicardial fat tissue was reported to be related to cardiometabolic diseases as metabolically active adipose tissue and natriuretic peptides (NPs) have been shown to have metabolic effects. This study's aim was to determine the relationship between epicardial fat thickness (EFT) and NPs in the female population diagnosed with GDM.
The study involved 161 pregnant women: 96 with GDM, and 65 healthy controls. GDM was diagnosed following the American Diabetes Association (2013) norms for diagnosing diabetes. All patients underwent echocardiography to measure EFT. N-terminal pro-brain natriuretic peptide (NT-proBNP) and other parameters were quantified in blood samples. The Independent Samples t-test, Pearson's correlation test, and a multivariable logistic regression analysis (LRA) were performed for statistical evaluation. A p-value <0.05 was considered statistically significant.
Fasting (91.46±14.29 mg/dl vs. 82.18±8.21 mg/dl) (p<0.001), first-hour (202.30± 21.60 mg/dl vs. 161.57±16.21 mg/dl) (p<0.001), and second-hour (176.95±20.43 mg/dl vs. 130.93±16.95 mg/dl) glucose levels (p<0.001), fasting insulin level (14.54±3.50 mUL/mL vs. 11.51±2.04 mUL/mL; p<0.001), and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) value (3.28±0.99 vs. 2.31±0.45; p<0.0001) in GDM Group were significantly higher than Control Group. The GDM Group also had significantly increased EFT values compared to the Control Group (4.74±0.65 mm vs. 3.77±0.66 mm; p<0.0001), whereas NT-proBNP levels of diabetic women were considerably lower compared to controls (21.59±19.86 pg/ml vs. 39.74±33.96 pg/ml; p<0.0001). In addition, EFT thickness and the NT-proBNP level were determined to be significantly negatively correlated (r=-32, p<0.0001).
EFT evaluation might play a prognostic role in detecting cardiometabolic risk associated with potential disorders such as GDM. This study showed a potential interplay between epicardial adipose tissue and NPs secreted by cardiomyocytes and practical effects on fat metabolism in GDM subjects.
患有妊娠糖尿病（GDM）的女性产后具有心血管（CV）风险因素增加和潜在 CV 风险增加的特征。心外膜脂肪组织被认为与心脏代谢疾病有关，因为利钠肽（NPs）已被证明具有代谢作用。本研究旨在确定患有 GDM 的女性人群中心外膜脂肪厚度（EFT）与 NPs 之间的关系。
该研究纳入了 161 名孕妇：96 名患有 GDM，65 名健康对照。GDM 是根据美国糖尿病协会（2013 年）诊断糖尿病的标准诊断的。所有患者均接受超声心动图检查以测量 EFT。在血液样本中定量测定 N-末端脑利钠肽前体（NT-proBNP）和其他参数。采用独立样本 t 检验、皮尔逊相关检验和多变量逻辑回归分析（LRA）进行统计评估。p 值<0.05 被认为具有统计学意义。
空腹（91.46±14.29 mg/dl 与 82.18±8.21 mg/dl）（p<0.001）、第一小时（202.30±21.60 mg/dl 与 161.57±16.21 mg/dl）（p<0.001）和第二小时（176.95±20.43 mg/dl 与 130.93±16.95 mg/dl）（p<0.001）的血糖水平、空腹胰岛素水平（14.54±3.50 mU/L/mL 与 11.51±2.04 mU/L/mL；p<0.001）和稳态模型评估的胰岛素抵抗（HOMA-IR）值（3.28±0.99 与 2.31±0.45；p<0.0001）在 GDM 组明显高于对照组。GDM 组的 EFT 值也明显高于对照组（4.74±0.65 mm 与 3.77±0.66 mm；p<0.0001），而糖尿病女性的 NT-proBNP 水平明显低于对照组（21.59±19.86 pg/ml 与 39.74±33.96 pg/ml；p<0.0001）。此外，EFT 厚度和 NT-proBNP 水平被确定为显著负相关（r=-32，p<0.0001）。
EFT 评估可能在检测与 GDM 等潜在疾病相关的心脏代谢风险方面发挥预后作用。本研究表明，心外膜脂肪组织和心肌细胞分泌的 NPs 之间存在潜在的相互作用，并对 GDM 患者的脂肪代谢产生实际影响。
