上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2025, Vol. 45 ›› Issue (1): 42-50.doi: 10.3969/j.issn.1674-8115.2025.01.005

• 论著 · 临床研究 • 上一篇    下一篇

腹部脂肪面积与2型糖尿病患者胰岛β细胞第一时相分泌功能的关系

陆佳萍1(), 刘醒2(), 张林杉2, 赵琳2, 张敏1, 李小英2, 刘玥隽2()   

  1. 1.复旦大学附属中山医院青浦分院内分泌科，上海 201700
    2.复旦大学附属中山医院内分泌科，上海 200032
  • 收稿日期:2024-07-09 接受日期:2024-10-15 出版日期:2025-01-28 发布日期:2025-01-28
  • 通讯作者: 刘玥隽 E-mail:lujiaping_1993@hotmail.com;liu.xing@zs-hospital.sh.cn;liu.yuejun@zs-hospital.sh.cn
  • 作者简介:陆佳萍（1993—），女，主治医师，硕士；电子信箱：lujiaping_1993@hotmail.com
    刘　醒 （1988—），女，主治医师，博士；电子信箱：liu.xing@zs-hospital.sh.cn。
    第一联系人：*为共同第一作者
  • 基金资助:
    国家自然科学基金(81900771);中山医院优秀青年项目(2019ZSYQ19);青浦区卫生健康委员会项目(QWJ2022-01)

Relationship between abdominal fat area and first-phase insulin secretion function of pancreatic β-cells in patients with type 2 diabetes

LU Jiaping1(), LIU Xing2(), ZHANG Linshan2, ZHAO Lin2, ZHANG Min1, LI Xiaoying2, LIU Yuejun2()   

  1. 1.Department of Endocrinology, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai 201700, China
    2.Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai 200032, China
  • Received:2024-07-09 Accepted:2024-10-15 Online:2025-01-28 Published:2025-01-28
  • Contact: LIU Yuejun E-mail:lujiaping_1993@hotmail.com;liu.xing@zs-hospital.sh.cn;liu.yuejun@zs-hospital.sh.cn
  • Supported by:
    National Natural Science Foundation of China(81900771);Excellent Youth Program of Zhongshan Hospital(2019ZSYQ19);Program of Shanghai Qingpu District Health Commission(QWJ2022-01)

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摘要：

目的·探讨2型糖尿病患者腹部脂肪面积与胰岛β细胞第一时相分泌功能之间的关系，并建立列线图预测模型。方法·选取2020年10月—2024年2月在复旦大学附属中山医院内分泌科住院并完善精氨酸刺激试验以评估胰岛β细胞第一时相分泌功能的2型糖尿病患者120例。根据试验结果，将患者分为胰岛素分泌功能残存组和功能衰竭组。收集患者的一般资料及实验室指标，通过内脏脂肪检测仪检测患者腹部皮下脂肪面积（subcutaneous fat area，SFA）和内脏脂肪面积（visceral fat area，VFA）。经单因素分析筛选变量，使用多因素Logistic回归确定影响因素，从而建立列线图预测模型。采用受试者操作特征曲线（receiver operating characteristic curve，ROC曲线）分析的曲线下面积（area under the curve，AUC）、一致性指数（concordance index，C-index）评估模型预测效能。结果·纳入的74例患者（61.7%）胰岛功能残存，46例（38.3%）胰岛功能衰竭。胰岛功能衰竭组患者糖尿病病程更长，腰围、臀围、体质量指数（body mass index，BMI）、尿酸、游离三碘甲状腺原氨酸（free triiodothyronine，FT3）、脂肪组织胰岛素抵抗指数（adipose tissue insulin resistance，Adipo-IR）、踝肱指数（ankle brachial index，ABI）、SFA和VFA水平较低，臂踝脉搏波速度（brachial ankle pulse wave velocity，baPWV）较快。多因素Logistic回归分析显示，SFA、VFA、FT3、baPWV和ABI是胰岛功能衰竭的独立危险因素。基于以上因素构建列线图模型，其中纳入VFA、FT3、ABI、baPWV的模型预测能力最佳，C-index为0.81。结论·胰岛β细胞第一时相分泌功能衰竭患者SFA和VFA均较低，纳入SFA或VFA的列线图可用于预测2型糖尿病患者β细胞第一时相分泌功能。

关键词: 2型糖尿病, 腹部脂肪面积, 胰岛功能, 列线图

Abstract:

Objective ·To explore the relationship between abdominal fat area and the first-phase insulin secretion function of pancreatic β-cells in patients with type 2 diabetes, and to establish predictive models of nomogram. Methods ·From October 2020 to February 2024, a total of 120 patients with type 2 diabetes, who were hospitalized in the Department of Endocrinology, Zhongshan Hospital, Fudan University, and underwent the arginine stimulation test, were recruited for the study. Patients were categorized into an insulin secretion function-preserved group (i.e. preserved group) and a depleted group according to the results of the arginine stimulation test. General information and laboratory parameters were collected. Subcutaneous fat area (SFA) and visceral fat area (VFA) were non-invasively measured by abdominal fat detector. The variables were screened by univariate analysis, and multivariate Logistic regression was used to identify the influencing factors, followed by the establishment of predictive models of nomogram. The area under the receiver operating characteristic curve (ROC curve) and concordance index (C-index) were used to evaluate the predictive performance of the models. Results ·Seventy-four patients (61.7%) were assigned to the preserved group, and 46 patients (38.3%) to the depleted group. Patients in the depleted group had a longer diabetes duration, lower waist circumference, hip circumference, body mass index (BMI), uric acid, free triiodothyronine (FT3), adipose tissue insulin resistance (Adipo-IR), ankle brachial index (ABI), SFA and VFA, and higher brachial ankle pulse wave velocity (baPWV). Multivariate Logistic regression showed that SFA, VFA, FT3, baPWV, and ABI were independent risk factors for the depleted insulin secretion function. Nomogram models were constructed based on the above risk factors. Among them, the model comprising VFA, FT3, ABI, and baPWV showed the best predictive performance with a C-index of 0.81. Conclusion ·SFA and VFA are lower in patients with depleted first-phase insulin secretion function of pancreatic β-cells. The nomogram model, including SFA or VFA, can be used to predict first-phase insulin secretion function of pancreatic β-cells in patients with type 2 diabetes.

Key words: type 2 diabetes, abdominal fat area, insulin secretion function, nomogram

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