脂肪组织对 2 型糖尿病与心率变异性降低之间关系的影响：中介分析。
Effects of adipose tissues on the relationship between type 2 diabetes mellitus and reduced heart rate variability: mediation analysis.
机构信息
Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Clinical Immunology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
出版信息
Cardiovasc Diabetol. 2024 Sep 28;23(1):353. doi: 10.1186/s12933-024-02438-1.
BACKGROUND
Type 2 diabetes mellitus (T2DM) is associated with decreased heart rate variability (HRV) with an unclear intermediate mechanism. This study aimed to conduct mediation analysis to explore the impact of various adipose tissues on the relationship between T2DM and HRV.
METHODS
A total of 380 participants were enrolled for analysis, including 249 patients with T2DM and 131 non-diabetic controls. The thicknesses of four adipose tissues (subcutaneous, extraperitoneal, intraperitoneal, and epicardial) were measured by abdominal ultrasound or echocardiography respectively. HRV was assessed by 24-hour Holter for monitoring both frequency domain indices (LF, HF, and LF/HF) and time domain indices (SDNN, SDANN, SDNN index, rMSSD and pNN50). Mediation analysis was used toexamine whether adipose tissues mediated the relationship between T2DM and each index of HRV. Then, a latent variable - HRV burden - was constructed by structural equation model with selected HRV indices to comprehensively assess the whole HRV.
RESULTS
Compared to non-diabetic controls, patients with T2DM exhibited a significant reduction in indices of HRV, and a remarkable increase in the thicknesses of extraperitoneal, intraperitoneal, and epicardial adipose tissues. Mediation analysis found significant indirect effects of T2DM on six indices of HRV, including HF, SDNN, SDANN, SDNN index, rMSSD, and pNN50, which was mediated by epicardial adipose tissue rather than other adipose tissues, with the mediation proportions of 64.21%, 16.38%, 68.33%, 24.34%, 24.10% and 30.51%, respectively. Additionally, epicardial adipose tissue partially mediated the relationship between T2DM and reduced HRV burden (24.26%), which composed by SDNN, SDNN index, rMSSD, and pNN50.
CONCLUSION
Epicardial adipose tissue partially mediated the relationship between T2DM and reduced HRV, which reinforces the value of targeting heart-specific visceral fat to prevent cardiac autonomic neuropathy in diabetes.
背景
2 型糖尿病（T2DM）与心率变异性（HRV）降低有关，但其中间机制尚不清楚。本研究旨在进行中介分析，以探讨各种脂肪组织对 T2DM 与 HRV 之间关系的影响。
方法
共纳入 380 名参与者进行分析，其中 249 名 T2DM 患者和 131 名非糖尿病对照者。通过腹部超声或超声心动图分别测量四种脂肪组织（皮下、腹膜外、腹膜内和心外膜）的厚度。通过 24 小时动态心电图监测 HRV，评估频域指标（LF、HF 和 LF/HF）和时域指标（SDNN、SDANN、SDNN 指数、rMSSD 和 pNN50）。采用中介分析方法探讨脂肪组织是否介导了 T2DM 与 HRV 各指标之间的关系。然后，通过结构方程模型构建一个由选定的 HRV 指标组成的 HRV 负荷的潜在变量，以全面评估整个 HRV。
结果
与非糖尿病对照组相比，T2DM 患者的 HRV 指标显著降低，而腹膜外、腹膜内和心外膜脂肪组织的厚度显著增加。中介分析发现，T2DM 对 HRV 的六个指标（HF、SDNN、SDANN、SDNN 指数、rMSSD 和 pNN50）有显著的间接影响，这些影响是由心外膜脂肪组织介导的，而不是其他脂肪组织介导的，介导比例分别为 64.21%、16.38%、68.33%、24.34%、24.10%和 30.51%。此外，心外膜脂肪组织部分介导了 T2DM 与 HRV 负荷降低之间的关系（24.26%），HRV 负荷由 SDNN、SDNN 指数、rMSSD 和 pNN50 组成。
结论
心外膜脂肪组织部分介导了 T2DM 与 HRV 降低之间的关系，这进一步证实了针对心脏特异性内脏脂肪来预防糖尿病自主神经病变的重要性。
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