胰岛素抵抗稳态模型评估指数与2型糖尿病 合并抑郁症的相关性研究

Study on the Correlation between the Homeostatic Model Assessment Index of Insulin Resistance and Type 2 Diabetes Mellitus Complicated with Depression

摘要: 目的：探讨胰岛素抵抗稳态模型评估指数与2型糖尿病合并抑郁症的相关性。方法：纳入2024年5月1日至2025年4月30日期间，于安徽医科大学第二附属医院内分泌科门诊及病房接受随访的2型糖尿病(T2DM)患者。收集人口学、临床、实验室资料，根据患者PHQ-9的评分将研究对象分为抑郁组与非抑郁组，比较两组患者临床特征。采用多因素logistic回归模型分析胰岛素抵抗指数与T2DM抑郁症的关系，构建包含常规危险因素的完全调整模型；同时在年龄、性别、病程、BMI等亚组中进行分层分析，利用限制性立方样条模型(RCS)曲线评估HOMA2IR (胰岛素抵抗指数)与抑郁的非线性关系，受试者工作特征(ROC)曲线分析HOMA-IR对T2DM抑郁症患者的预测价值。结果：本研究共纳入465例T2DM患者，年龄(55.24 ± 13.23)岁，其中男性292例(62.8%)。抑郁组218例(46.9%)，非抑郁组247例(53.1%)。抑郁组HOMA2IR水平高于非抑郁组[1.92 (1.51, 2.49)比1.80 (1.29, 2.11), p < 0.001]。HOMA2IR升高(OR = 1.75, 95% CI: 1.32~2.32)是T2DM抑郁症的危险因素。按四分位分组后，最高四分位组抑郁评分为最低四分位组的2.66倍(OR = 2.66, 95% CI: 1.57~4.51)。将HOMA2IR纳入完全调整模型后，HOMA2IR与T2DM抑郁的关系进一步增强(OR = 1.87, 95% CI: 1.39~2.53, p < 0.001)。亚组分析显示，HOMA2IR在年龄 < 60岁(p < 0.01)、高血压患者(p < 0.01)中的预测价值更为显著。ROC曲线分析显示，HOMA-IR对T2DM抑郁症有预测价值，最佳临界值为2.465。结论：HOMA2IR是T2DM患者发生抑郁的独立危险因素，并且具有预测价值。即当HOMA2IR达到2.465时，需警惕患者糖尿病合并抑郁症。

Abstract: Objective: To explore the correlation between the homeostasis model assessment index of insulin resistance and diabetic depression. Methods: A prospective study was conducted on patients with type 2 diabetes who were followed up at the outpatient clinic and inpatient wards of the Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, from May 1, 2024, to April 30, 2025. Demographic, clinical, and laboratory data were collected. The subjects were divided into a depression group and a non-depression group based on their PHQ-9 scores. The clinical characteristics of the two groups were compared. A multivariate logistic regression model was used to analyze the relationship between the insulin resistance index and diabetic depression, and a fully adjusted model including conventional risk factors was constructed. Meanwhile, stratified analyses were performed in subgroups such as age, gender, disease duration, and BMI. Restricted cubic spline (RCS) curves were used to evaluate the non-linear relationship between HOMA2IR (insulin resistance index) and depression, and receiver operating characteristic (ROC) curves were used to analyze the predictive value of HOMA-IR for patients with type 2 diabetic depression. Results: A total of 465 patients with type 2 diabetes were included in this study, with an age of (55.24 ± 13.23) years, including 292 males (62.8%). There were 218 cases in the depression group (46.9%) and 247 cases in the non-depression group (53.1%). The level of HOMA2IR in the depression group was higher than that in the non-depression group [1.92 (1.51, 2.49) vs. 1.80 (1.29, 2.11), p < 0.001]. An increase in HOMA2IR (OR = 1.75, 95% CI: 1.32~2.32) was a risk factor for diabetic depression. After grouping by quartiles, the depression score in the highest quartile group was 2.66 times that of the lowest quartile group (OR = 2.66, 95% CI: 1.57~4.51). After including HOMA2IR in the fully adjusted model, the relationship between HOMA2IR and diabetic depression was further strengthened (OR = 1.87, 95% CI: 1.39~2.53, p < 0.001). Subgroup analysis showed that the predictive value of HOMA2IR was more significant in patients aged < 60 years (p < 0.01) and those with hypertension (p < 0.01). ROC curve analysis showed that HOMA-IR had predictive value for diabetic depression, with the optimal cut-off value being 2.465. Conclusion: HOMA2IR is an independent risk factor for depression in patients with T2DM, and HOMA2IR has predictive value for diabetic depression. That is, when HOMA2IR reaches 2.465, vigilance should be paid to patients with diabetes complicated by depression.