H<sub>2</sub>FPEF评分、NT-proBNP联合LVDF在射血分数保留的2型糖尿病患者DCM危险程度中的评估价值

doi:10.3969/j.issn.1671-7171.2023.05.006

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摘要【目的】探讨H₂FPEF评分、N端B型利钠肽前体(NT-proBNP)联合左心室舒张功能(LVDF)在射血分数(EF)保留的2型糖尿病(T2DM)患者糖尿病心肌病(DCM)危险程度中的评估价值。【方法】回顾性分析2014年2月至2019年4月在深圳市第二人民医院诊治的593例EF≥50%的T2DM患者的临床资料。以H₂FPEF评分、NT-proBNP和LVDF为关键指标,首先采用聚类分析方法对研究人群进行DCM危险程度分类,获得DCM危险分期;然后对上述分期进行Fisher判别分析,获得DCM危险分期的判断方法。【结果】通过聚类分析将研究对象分为DCM危险4期:1期为DCM低危期,有98例(16.52%),其H₂FPEF低评分为(0.52±0.50)分,NT-proBNP为(38.98±24.80)pg/mL,LVDF正常;2期为DCM中危期,有469例(79.09%),其H₂FPEF低评分为(1.47±0.92)分,NT-proBNP正常[(61.79±54.22)pg/mL],LVDF降低;3期为DCM高危期,有17例(2.87%),其H₂FPEF低评分为(1.53±1.18)分,NT-proBNP升高[(344.18±106.94)pg/mL],LVDF降低;4期为极高危期,有9例(1.52%),其中H₂FPEF评分为(2.89±1.17)分、NT-proBNP升高[(550.44±153.87)pg/mL],LVDF降低。对上述4期进行Fisher判别分析获得4个贝叶斯判别函数,准确率均大于90%,该判别函数可对EF≥50%的T2DM患者进行DCM危险分期的判断。【结论】H₂FPEF评分、NT-proBNP联合LVDF为评价EF保留的T2DM患者DCM危险程度提供了一种新判断方法。

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关键词 ：糖尿病, 2型, 心肌病, 扩张型, 利钠肽,脑/血液, 心排血量

Abstract：【Objective】 To investigate the effects of H₂FPEF score, N-terminal B-type natriuretic peptide precursor (NT-proBNP) combined with left ventricular diastolic function (LVDF) on the evaluation value of risk degree of diabetes cardiomyopathy (DCM) in patients with type 2 diabetes (T2DM) with ejection fraction (EF) preserved. 【Methods】 A retrospective analysis was conducted on the clinical data of 593 T2DM patients with EF ≥ 50% who were treated at the Shenzhen Second People's Hospital from February 2014 to April 2019. Using H₂FPEF score, NT-proBNP and LVDF as key indicators ,the cluster analysis was first used to classify the DCM risk level of the study population and obtain the DCM risk staging; Then Fisher discriminant analysis on the above stages was perform to obtain a method for determining the risk stage of DCM. 【Results】Through cluster analysis, the study subjects were divided into four phases of DCM risk: the Phase 1 was a low-risk stage of DCM, with 98 cases (16.52%) having a low H₂FPEF score of (0.52 ± 0.50), an NT-proBNP score of (38.98 ± 24.80) pg/mL, and a normal LVDF; the Phase 2 was a moderate risk stage for DCM, with 469 cases (79.09%) having a low H₂FPEF score of (1.47 ± 0.92), normal NT-proBNP [(61.79 ± 54.22) pg/mL], and reduced LVDF; the Phase 3 was a high-risk period for DCM, with 17 cases (2.87%) having a low H₂FPEF score of (1.53 ± 1.18), an increase in NT-proBNP[(344.18 ± 106.94) pg/mL], and a decrease in LVDF; the Phase 4 was a very high-risk period, with 9 cases (1.52%), with an H₂FPEF score of (2.89 ± 1.17), an increase in NT-proBNP [(550.44±153.87) pg/mL] and a decrease in LVDF. Four Bayesian discriminant functions were obtained through Fisher discriminant analysis on the above four periods, with accuracy rates greater than 90%. This discriminant function could be used to determine the DCM risk staging for T2DM patients with EF ≥ 50%. 【Conclusions】The H₂FPEF score, NT-proBNP combined with LVDF provide a new method for evaluating the risk of DCM in T2DM patients with EF preservation.

Key words： Diabetes Mellitus, Type 2 Cardiomyopathy, Dilated Natriuretic Peptide, Brain/BL Cardiac Output

收稿日期: 2022-10-06

中图分类号:

R587.23

基金资助:国家自然科学基金面上项目(项目批准号:81670759)

通讯作者: **E-mail:yandw963@126.com

引用本文:

刘雪婷, 邓建新, 李海燕, 郝明瑜, 欧慧婷, 阎德文. H₂FPEF评分、NT-proBNP联合LVDF在射血分数保留的2型糖尿病患者DCM危险程度中的评估价值[J]. 医学临床研究, 2023, 40(5): 659-663.
LIU Xue-ting, DENG Jian-xin, LI Hai-yan, et al. Evaluation Value of H₂FPEF Score, NT-proBNP and LVDF in the Risk of DCM in Type 2 Diabetes Patients with Ejection Fraction Preserved. JOURNAL OF CLINICAL RESEARCH, 2023, 40(5): 659-663.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2023.05.006 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2023/V40/I5/659