Study on the relationship between systemic immune-inflammation index and abnormal electrocardiogram in patients with type 2 diabetes
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摘要: 目的 探讨系统性免疫炎症指数(SII)与2型糖尿病患者(T2DM)异常心电图类型的相关性及预测T2DM患者异常心电图类型的价值。方法 回顾性纳入2022年1月—2023年4月在北京大学第三医院收治的436例T2DM患者作为研究对象。根据SII评分将患者分为SII低分组和SII高分组。采用多因素logistic回归分析SII与T2DM患者心电图异常之间的关系。同时，通过构建相关性及其预测价值模型(ROC)评估SII对T2DM患者心电图异常的预测价值。结果 相较于SII低分组，SII高分组患者出现心动过速(OR=2.44，95%CI：1.30~4.58，P=0.006)和ST-T改变(OR=1.75，95%CI：1.03~2.97，P=0.039)的风险增加；但SII与心动过缓、期前收缩、房室传导阻滞和心束支传导阻滞等心电图异常类型之间无关联性。进一步ROC分析显示，SII预测T2DM患者发生心动过速的曲线下面积为0.620(95%CI：0.538~0.720，P=0.005)，预测ST-T改变的曲下面积为0.551(95%CI：0.475~0.628，P=0.039)。结论 SII与T2DM患者发生心动过速、ST-T改变有关，对T2DM发生心动过速、ST-T改变的诊断具有预测价值，可为T2DM患者心脏功能异常的预防提供参考。Abstract: Objective To investigate the correlation between systemic immuno-inflammatory index(SII) and abnormal electrocardiogram types in type 2 diabetes mellitus(T2DM) patients and the value of predicting abnormal ECG types in T2DM patients.Methods A retrospective study was conducted on 436 T2DM patients from Peking University Third Hospital from January 2022 to April 2023. The patients were divided into the low SII group and high SII group using SII score. Logistic regression was used to explore the relationship between SII and the types of electrocardiogram abnormalities in T2DM patients. The diagnostic value of SII for the types of electrocardiogram abnormalities in T2DM patients was analyzed by constructing an ROC model.Results Compared with the low SII group, patients in the high SII group had an increased risk of tachycardia(OR=2.438, 95%CI: 1.297-4.583, P=0.006) and ST-T changes(OR=1.749, 95%CI: 1.03-2.97, P=0.039). However, there was no statistically significant difference in bradycardia, premature contractions, atrioventricular block, and bundle branch block between the two groups. The ROC model revealed that the area under curves for SII predicting tachycardia were(95%CI: 0.538-0.720, P=0.005) and ST-T changes(95%CI: 0.475-0.628, P=0.039), respectively.Conclusion SII is associated with the occurrence of tachycardia and ST-T changes in patients with T2DM, and has a predictive value for the diagnosis of tachycardia and ST-T changes occurring in T2DM, which may provide a reference for the prevention of cardiac function abnormalities in patients with T2DM.
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图 1 SII预测T2DM患者心动过速和ST-T改变的ROC曲线
Figure 1. ROC curves of SII predicting tachycardia and ST-T changes in patients with T2DM
表 1 研究对象临床特征
Table 1. Clinical characteristics of included subjects
例(%), X±S 分类 总体(436例) SII低分组(218例) SII高分组(218例) χ2/t值 P值 年龄 0.589 0.443 ＜60岁 230(52.75) 111(50.92) 119(54.59) ≥60岁 206(47.25) 107(49.08) 99(45.41) 性别 1.799 0.180 男 222(50.92) 104(47.71) 118(54.13) 女 214(49.08) 114(52.29) 100(45.87) BMI 2.669 0.263 ＜18.5 kg/m2 14(3.21) 10(4.59) 4(1.83) 18.5~23.9 kg/m2 202(46.33) 99(45.41) 103(47.25) ≥24 kg/m2 220(50.46) 109(50.00) 111(50.92) 高血压 152(34.86) 78(35.78) 74(33.94) 0.162 0.688 冠心病 78(17.89) 38(17.43) 40(18.35) 0.062 0.803 吸烟 114(26.15) 62(28.44) 52(23.85) 1.188 0.276 饮酒 92(21.10) 50(22.94) 42(18.35) 0.882 0.348 HbA1c/% 9.54±2.13 9.42±2.21 9.66±2.05 -1.215 0.225 UA/(μmol/L) 268.82±76.37 271.58±76.42 266.06±76.38 0.755 0.451 TC/(mmol/L) 4.68±0.98 4.6±0.95 4.76±0.99 -1.666 0.096 TG/(mmol/L) 1.71±0.48 1.7±0.5 1.72±0.47 -0.368 0.713 HDL-C/(mmol/L) 1.11±0.32 1.14±0.31 1.08±0.33 2.069 0.039 LDL-C/(mmol/L) 2.93±0.94 2.95±0.94 2.9±0.95 0.528 0.598 
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表 2 SII与T2DM患者心电图异常类型的logistic回归分析
Table 2. Relationship between SII and abnormal ECG types in T2DM patients analyzed by logistic regression analysis
分组 心动过缓 期前收缩 房室传导阻滞 心动过速 心束支传导阻滞 ST-T改变 SII低分组(218例) 57(26.15) 47(21.56) 19(8.72) 16(7.34) 17(7.80) 27(12.39) SII高分组(218例) 58(26.61) 50(22.94) 14(6.42) 35(16.06) 19(8.72) 43(19.72) OR(95%CI) 0.98
(0.64~1.51)1.05
(0.66~1.66)0.75
(0.36~1.55)2.44
(1.30~4.58)1.18
(0.59~2.37)1.75
(1.03~2.97)P值 0.927 0.841 0.432 0.006 0.640 0.039 注：以SII低分组为参照，调整了研究对象的性别、年龄、BMI、高血压、冠心病、吸烟及饮酒状况。
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