胰岛素抵抗代谢评分对原发性高血压患者并发主动脉弓钙化的预测价值

doi:10.3969/j.issn.1004-583X.2025.07.002

摘要/Abstract

摘要：

目的探究胰岛素抵抗代谢评分(metabolic score for insulin resistance, METS-IR)对原发性高血压患者并发主动脉弓钙化(aortic arch calcification, AAC)的预测价值。方法回顾性选取北京市仁和医院2022年2月-2025年2月收治的原发性高血压患者170例,依据Symeonidis法进行主动脉弓钙化评分(aortic arch calcification score, AoACS)评分测定,分为AoACS=0组(n=60)、AoACS=1组(n=46)、AoACS=2组(n=33)和AoACS=3组(n=31)。比较吸烟史、饮酒史、糖尿病史、性别、年龄、血压、体重指数(body mass index,BMI)、甘油三酯、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)、空腹血糖(fasting plasma glucose, FPG),分析各指标与原发性高血压患者并发AAC的相关性及预测价值。结果 4组饮酒史占比、性别、甘油三酯水平差异均无统计学意义(P>0.05)。4组吸烟史占比、糖尿病史占比、年龄、舒张压、收缩压、LDL-C水平、HDL-C水平、FPG水平、BMI、METS-IR差异均有统计学意义(P<0.05)。以METS-IR、吸烟史、糖尿病史、年龄、LDL-C、HDL-C、FPG、BMI、收缩压、舒张压作自变量,行有序logistic回归分析;结果表明,HDL-C为AAC的保护性因素,其余指标均为AAC的危险因素(P<0.05)。绘制受试者工作特征曲线显示,METS-IR水平预测原发性高血压并发AAC的曲线下面积为0.92,特异度96.67%,敏感度80.00%(P<0.001)。结论 METS-IR、年龄、吸烟、LDL-C、糖尿病史、FPG、BMI、收缩压、舒张压为AAC的危险因素,HDL-C为AAC的保护性因素;METS-IR预测价值更高。

关键词: 原发性高血压, 胰岛素抵抗代谢评分, 主动脉弓钙化, 回顾性分析

Abstract:

Objective To explore the predictive value of metabolic score for insulin resistance (METS-IR) in patients with essential hypertension combined with aortic arch calcification (AAC). Methods A total of 170 patients with essential hypertension admitted in the Beijing Renhe Hospital from February 2022 to February 2025 were retrospectively selected. According to the Symeonidis method, the aortic arch calcification score (AoACS) was measured and divided patients into the AoACS =0 group (n=60), AoACS =1 group (n=46), AoACS=2 group (n=33) and AoACS=3 group (n=31). Smoking history, drinking history, diabetes history, gender, age, blood pressure, body mass index (BMI), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and fasting plasma glucose (FPG) were compared. The correlation and predictive value of each index with AAC in patients with essential hypertension were analyzed. Results There were no significant differences in the proportions of drinking history, gender and TG level among the four groups (P>0.05). There were significant differences in the proportion of smoking history, the proportion of diabetes history, age, diastolic blood pressure, systolic blood pressure, LDL-C, HDL-C, FPG, BMI and METS-IR among the four groups (P<0.05). METS-IR, smoking history, diabetes history, age, LDL-C, HDL-C, FPG, BMI, systolic blood pressure and diastolic blood pressure were used as independent variables for ordinal logistic regression analysis. The results showed that HDL-C was a protective factor for AAC, and the other indicators were risk factors for AAC (P<0.05). The receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of METS-IR in predicting primary hypertension complicated with AAC was 0.92, with a specificity of 96.67%, and a sensitivity of 80.00%(P<0.001). Conclusion METS-IR, age, smoking, LDL-C, diabetes history, FPG, BMI, and blood pressure (both systolic and diastolic) are significant risk factors for AAC in patients with essential hypertension, while HDL-C serves as a protective factor. METS-IR demonstrated superior predictive value for the presence and severity of AAC.

Key words: essential hypertension, metabolic score for insulin resistance, aortic arch calcification, retrospective analysis

中图分类号:

R544.1

刘胜华. 胰岛素抵抗代谢评分对原发性高血压患者并发主动脉弓钙化的预测价值[J]. 临床荟萃, 2025, 40(7): 589-594.

Liu Shenghua. The predictive value of the metabolic score for insulin resistance in essential hypertension patients complicated by aortic arch calcification[J]. Clinical Focus, 2025, 40(7): 589-594.

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链接本文: http://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2025.07.002

http://www.lchc.cn/CN/Y2025/V40/I7/589

图/表 5

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项目	AoACS=0组 (n=60)	AoACS=1组 (n=46)	AoACS=2组 (n=33)	AoACS=3组 (n=31)	χ²值	P值
吸烟史[例(%)]	21(35.00)	18(39.13)	20(60.61)^*	22(70.97)^*#	3.533	0.002
饮酒史[例(%)]	24(40.00)	24(52.17)	18(54.55)	22(70.97)	1.231	0.177
糖尿病史[例(%)]	19(31.67)	22(47.83)	18(54.55)^*	19(61.29)^*	2.214	0.030
男性[例(%)]	23(38.33)	22(47.83)	17(51.52)	18(58.06)	1.256	0.172
年龄(岁)	58.6±10.72	58.85±9.01	61.52±9.81	70.65±5.72^*#△	3419.919	<0.001
舒张压(mmHg)	92.52±3.34	97.46±4.51^*	102.60±4.40^*#	107.00±2.59^*#△	5002.699	<0.001
收缩压(mmHg)	146.90±4.76	156.80±5.72^*	167.20±4.88^*#	170.70±7.90^*#	15309.362	<0.001
TG(mmol/L)	1.57±0.44	1.81±0.48	1.74±0.23	1.84±0.53	1.310	0.084
LDL-C(mmol/L)	3.47±0.77	3.65±0.95	4.37±0.34^*#	4.69±0.81^*#	64.787	<0.001
HDL-C(mmol/L)	1.43±0.32	1.31±0.29	1.22±0.37^*	1.23±0.33^*	1.430	0.001
FPG(mmol/L)	6.51±1.30	6.74±1.79	7.51±1.29^*	8.21±2.17^*#△	70.123	<0.001
BMI(kg/m²)	21.07±2.22	23.69±2.09^*	25.36±4.23^*	28.68±4.02^*#△	1048.057	<0.001
METS-IR	30.57(28.73~31.62)	36.16(33.85~38.62)^*	40.38(37.03~42.08)^*#	43.93(40.31~47.31)^*#△	3934.159	<0.001

项目	AoACS=0组 (n=60)	AoACS=1组 (n=46)	AoACS=2组 (n=33)	AoACS=3组 (n=31)	χ²值	P值
吸烟史[例(%)]	21(35.00)	18(39.13)	20(60.61)^*	22(70.97)^*#	3.533	0.002
饮酒史[例(%)]	24(40.00)	24(52.17)	18(54.55)	22(70.97)	1.231	0.177
糖尿病史[例(%)]	19(31.67)	22(47.83)	18(54.55)^*	19(61.29)^*	2.214	0.030
男性[例(%)]	23(38.33)	22(47.83)	17(51.52)	18(58.06)	1.256	0.172
年龄(岁)	58.6±10.72	58.85±9.01	61.52±9.81	70.65±5.72^*#△	3419.919	<0.001
舒张压(mmHg)	92.52±3.34	97.46±4.51^*	102.60±4.40^*#	107.00±2.59^*#△	5002.699	<0.001
收缩压(mmHg)	146.90±4.76	156.80±5.72^*	167.20±4.88^*#	170.70±7.90^*#	15309.362	<0.001
TG(mmol/L)	1.57±0.44	1.81±0.48	1.74±0.23	1.84±0.53	1.310	0.084
LDL-C(mmol/L)	3.47±0.77	3.65±0.95	4.37±0.34^*#	4.69±0.81^*#	64.787	<0.001
HDL-C(mmol/L)	1.43±0.32	1.31±0.29	1.22±0.37^*	1.23±0.33^*	1.430	0.001
FPG(mmol/L)	6.51±1.30	6.74±1.79	7.51±1.29^*	8.21±2.17^*#△	70.123	<0.001
BMI(kg/m²)	21.07±2.22	23.69±2.09^*	25.36±4.23^*	28.68±4.02^*#△	1048.057	<0.001
METS-IR	30.57(28.73~31.62)	36.16(33.85~38.62)^*	40.38(37.03~42.08)^*#	43.93(40.31~47.31)^*#△	3934.159	<0.001

变量	赋值
因变量
AoACS得分	1=未见钙化影组,2=小点状或单个薄片状钙化影组,3=一个或多个区域的粗钙化影组,4=环形钙化影组
自变量
糖尿病史	1=无病史,2=有病史
吸烟史	1=无,2=有
年龄	连续性变量
LDL-C	连续性变量
HDL-C	连续性变量
FPG	连续性变量
BMI	连续性变量
收缩压	连续性变量
舒张压	连续性变量
METS-IR	连续性变量

变量	赋值
因变量
AoACS得分	1=未见钙化影组,2=小点状或单个薄片状钙化影组,3=一个或多个区域的粗钙化影组,4=环形钙化影组
自变量
糖尿病史	1=无病史,2=有病史
吸烟史	1=无,2=有
年龄	连续性变量
LDL-C	连续性变量
HDL-C	连续性变量
FPG	连续性变量
BMI	连续性变量
收缩压	连续性变量
舒张压	连续性变量
METS-IR	连续性变量

自变量	回归系数	标准误	Waldχ²值	P值	OR值	95%CI
METS-IR	0.405	0.042	93.404	<0.001	1.50	0.323~0.488
吸烟史	1.015	0.286	12.611	<0.001	2.76	0.455~1.575
糖尿病史	0.835	0.283	8.681	0.003	2.30	0.279~1.390
年龄	0.071	0.015	23.087	<0.001	1.07	0.042~0.100
LDL-C	1.723	0.216	63.492	<0.001	5.60	1.299~2.147
HDL-C	-2.026	0.518	15.267	<0.001	0.13	-3.042~-1.01
FPG	0.394	0.086	20.896	<0.001	1.48	0.225~0.564
BMI	0.480	0.057	71.710	<0.001	1.62	0.369~0.591
收缩压	0.311	0.032	94.539	<0.001	1.36	0.248~0.373
舒张压	0.411	0.042	96.812	<0.001	1.51	0.329~0.493