作者：张宁，郝丽慧，兰建强，陈淑霞，谷剑

单位：

1.063210河北省唐山市，华北理工大学研究生学院　2.075000河北省张家口市，河北北方学院研究生学院　3.050051河北省石家庄市，河北省人民医院心内科

Units：

1.Graduate School of North China University of Science and Technology, Tangshan 063210, China2.Graduate School of Hebei North University, Zhangjiakou 075000, China3.Department of Cardiology, Hebei General Hospital, Shijiazhuang 050051, China

关键词：

高血压；心肌病，肥厚性；胰岛素抵抗；预测

Keywords：

Hypertension; Cardiomyopathy, hypertrophic; Insulin resistance; Forecasting

CLC：

　R 544.1 R 542.2

DOI：

10.12114/j.issn.1008-5971.2023.00.135

Funds：

2020年度河北省医学科学研究课题计划项目（20200712）

摘要：

目的　探讨4种简易胰岛素抵抗（IR）指标对高血压患者发生左心室肥厚（LVH）的预测价值。方法回顾性选取2020年1月至2022年4月于河北省人民医院住院的高血压患者422例为研究对象，收集患者的临床资料，计算三酰甘油葡萄糖指数（TyG）、三酰甘油葡萄糖-体质指数（TyG-BMI）、三酰甘油与高密度脂蛋白胆固醇比值（TG/HDL-C）及胰岛素抵抗代谢评分（METS-IR），根据左心室质量指数（LVMI）〔LVMI≥115 g/m2（男）、≥95g/m2（女）〕将患者分为LVH组及非LVH组。高血压患者发生LVH的影响因素分析采用多因素Logistic回归分析；采用ROC曲线分析TyG、TyG-BMI、TG/HDL-C及METS-IR对高血压患者发生LVH的预测价值。结果　422例高血压患者中发生LVH 92例，LVH发生率为21.8%。两组性别、年龄、有吸烟史者占比、入院时收缩压、入院时脉压、Hb、TG、TyG、TG/HDL-C比较，差异有统计学意义（P＜0.05）。多因素Logistic回归分析结果显示，性别、TG/HDL-C为高血压患者发生LVH的独立影响因素（P＜0.05）。ROC曲线分析结果显示，TyG、TyG-BMI、TG/HDL-C、METS-IR预测高血压患者发生LVH的AUC分别为0.586〔95%CI（0.520，0.652）〕、0.521〔95%CI（0.451，0.591）〕、0.555〔95%CI（0.485，0.625）〕、0.527〔95%CI（0.455，0.599）〕，预测男性高血压患者发生LVH的AUC分别为0.745〔95%CI（0.642，0.848）〕、0.688〔95%CI（0.550，0.826）〕、0.793〔95%CI（0.687，0.899）〕、0.745〔95%CI（0.611，0.879）〕，预测女性高血压患者发生LVH的AUC分别为0.657〔95%CI（0.576，0.739）〕、0.531〔95%CI（0.446，0.616）〕、0.626〔95%CI（0.541，0.711）〕、0.527〔95%CI（0.439，0.614）〕。结论　性别、TG/HDL-C是高血压患者发生LVH的独立影响因素，TyG、TG/HDL-C、METS-IR对男性高血压患者发生LVH具有一定预测价值。

Abstract：

　Objective To investigate the predictive value of four simple insulin resistance (IR) indicators for leftventricular hypertrophy (LVH) in patients with hypertension. Methods A total of 422 hypertension patients hospitalized inHebei General Hospital from January 2020 to April 2022 were retrospectively selected as the research objects. The clinical dataof the patients were collected, and the triglyceride glucose index (TyG) , triglyceride glucose index-body mass index (TyG-BMI) ,triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-C) , and metabolic score for insulin resistance (METS-IR) werecalculated. According to the left ventricular mass index (LVMI) [LVMI ≥ 115 g/m2 (male) , ≥ 95 g/m2 (famale) ] , patients weredivided into LVH group and non LVH group. Multivariate Logistic regression analysis was used to explore the influencing factorsof LVH in hypertension patients; ROC curve was used to evaluate the predictive value of TyG, TyG-BMI, TG/HDL-C and METSIR for LVH in hypertension patients. Results Among 422 hypertension patients, 92 cases had LVH, incidence rate of LVH was21.8%. There were significant differences in gender, age, proportion of patients with history of smoking, systolic blood pressureat admission, pulse pressure at admission, Hb, TG, TyG, TG/HDL-C between the two groups (P < 0.05) . Multivariate Logisticregression analysis showed that gender, TG/HDL-C were independent influencing factors for LVH in hypertension patients (P < 0.05) . The results of ROC curve analysis showed that the AUC of TyG, TyG-BMI, TG/HDL-C and METS-IR for predicting LVHin hypertension patients was 0.586 [95%CI (0.520, 0.652) ] , 0.521 [95%CI (0.451, 0.591) ] , 0.555 [95%CI (0.485, 0.625) ] ,0.527 [95%CI (0.455, 0.599) ] ; the AUC of TyG, TyG-BMI, TG/HDL-C and METS-IR for predicting LVH in male hypertensionpatients was 0.745 [95%CI (0.642, 0.848) ] , 0.688 [95%CI (0.550, 0.826) ] , 0.793 [95%CI (0.687, 0.899) ] , 0.745 [95%CI(0.611, 0.879) ] ; the AUC of TyG, TyG-BMI, TG/HDL-C and METS-IR for predicting LVH in female hypertension patients was0.657 [95%CI (0.576, 0.739) ] , 0.531 [95%CI (0.446, 0.616) ] , 0.626 [95%CI (0.541, 0.711) ] , 0.527 [95%CI (0.439, 0.614) ] .Conclusion Gender, TG/HDL-C are independent influencing factors for LVH in hypertension patients. TyG, TG/HDL-C,METS-IR have certain predictive value for LVH in male hypertension patients.

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