Shea Erin V, Yu Sunkyung, Schumacher Kurt R, Lowery Ray, Doman Tammy, Rocchini Albert P
Pediatric Cardiology, Duke University Medical Center, Durham, NC, USA.
Division of Pediatric Cardiology, University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, 1540 East Medical Center Drive, Ann Arbor, MI, 48109-420, USA.
Pediatr Cardiol. 2024 Oct 7. doi: 10.1007/s00246-024-03663-x.
Patients with a single ventricle heart who had Fontan palliation (S/P Fontan) are at increased risk for acquired morbidity. Insulin resistance (IR) is a predictor of cardiac morbidity and mortality. A single-center, cross-sectional study using S/P Fontan and controls was designed to assess IR S/P Fontan. Group comparisons were made in IR via the Quantitative Insulin Index (QUICKI) and the natural log-transformed homeostasis model assessment, ln (HOMA-IR), without/with adjusting for age. A total of 89 patients (59 Fontan and 30 controls) were included. Fontan patients showed a significant decrease in QUICKI (0.34 ± 0.03 vs 0.37 ± 0.02) and an elevation of ln (HOMA-IR) (0.82 ± 0.62 vs 0.24 ± 0.44) compared to controls (both p < 0.0001); this remained significant even adjusting for age. With older age, there was a significant, progressive decrease in QUICKI (p = 0.01) and an increase in ln (HOMA-IR) (p = 0.02) S/P Fontan. Analysis excluding Fontan patients with obesity still showed a significant reduction of QUICKI and an elevation of ln (HOMA-IR) in Fontan patients compared to controls when adjusting for age (both p < 0.05). Using QUICKI, IR was present in 41 (69.5%) Fontan patients vs. 3 (10%) controls (p < 0.0001) and using HOMA-IR, IR was present in 32 (54.2%) vs 5 (16.7%) controls (p = 0.001). Fontan patients had significantly more IR compared to controls and the prevalence of IR increases with age. Since IR is known to correlate with long-term morbidity and mortality and can be ameliorated by therapies, we believe it is critical that IR be identified as early as possible in Fontan patients.
接受Fontan姑息手术（Fontan术后）的单心室心脏病患者发生后天性疾病的风险增加。胰岛素抵抗（IR）是心脏疾病和死亡的一个预测指标。一项使用Fontan术后患者和对照组的单中心横断面研究旨在评估Fontan术后患者的IR情况。通过定量胰岛素指数（QUICKI）和自然对数转换的稳态模型评估（ln[HOMA-IR]）对两组进行IR比较，比较时未调整年龄和调整年龄后进行比较。总共纳入了89例患者（59例Fontan术后患者和30例对照组）。与对照组相比，Fontan术后患者的QUICKI显著降低（0.34±0.03 vs 0.37±0.02），ln（HOMA-IR）升高（0.82±0.62 vs 0.24±0.44）（两者p<0.0001）；即使调整年龄后，这一差异仍具有统计学意义。随着年龄增长，Fontan术后患者的QUICKI显著逐渐降低（p=0.01），ln（HOMA-IR）升高（p=0.02）。排除肥胖的Fontan术后患者后进行分析，调整年龄后，与对照组相比，Fontan术后患者的QUICKI仍显著降低，ln（HOMA-IR）仍升高（两者p<0.05）。使用QUICKI评估时，41例（69.5%）Fontan术后患者存在IR，而对照组为3例（10%）（p<0.0001）；使用HOMA-IR评估时，32例（54.2%）Fontan术后患者存在IR，而对照组为5例（16.7%）（p=0.001）。与对照组相比，Fontan术后患者的IR明显更多，且IR患病率随年龄增加。由于已知IR与长期疾病和死亡相关，并且可以通过治疗改善，我们认为尽早识别Fontan术后患者的IR至关重要。
