目前研究顯示左心室肥厚及胰島素抗性與頸動脈內膜中層厚度相關，頸動脈 內膜中層厚度是高血壓 糖尿病及及中高齡族群亞臨床動脈粥樣硬化的指標 但在健康年輕族群中，這種關聯性尚不清楚。因此，本研究旨在釐清台灣陸軍年輕成年軍人其心電圖，心臟超音波檢查參數及各種非胰島素測量胰島素抗性指數與頸動脈內膜中層厚度之間的關聯性。我們紀錄自2018年至2020年，共有1822名18歲至40歲的台灣軍人接受年度健康檢查，其中包括心電圖和心臟超音波檢查。透過高解析度頸部超音波檢查測量左頸動脈球內膜中層厚度。臨床參數紀錄包括各項生理及血液生化檢查。以共變異數分析比較心電圖和心臟超音波參數特徵。另外分別測試四種非胰島素測量胰島素抗性指數(簡稱nIIR):三酸甘油酯濃度糖TyG 指數，三酸甘油酯/高密度脂蛋白比率糖胰島素抗性代謝評分(METS-IR)，以多變量線性迴歸分析來確定相關性。結果顯示心電圖定義的左心室肥厚，右心室肥厚和心率≥75/min的受試者與頸動脈內膜中層厚度≥0.8 mm呈正相關，而心臟超音波檢查左心室肥厚受試者與頸動脈內膜中層厚度≥0.8 mm呈負相關。所有參與者的頸動脈內膜中層厚度和三酸甘油酯之間存在關聯。較好的體適能表現會造成心肌肥厚但可能會降低動脈粥狀硬化的嚴重程度，導致心臟超音波與心電圖檢查結果矛盾 。這項研究表基於心心電圖顯示的三酸甘油酯可作為軍人族群中亞臨床動脈粥狀硬化的良好標誌。另外非胰島素測量下胰島素抗性指數可用心評估肥胖和無高病酸血症的年輕成年人族群頸動脈內膜中層厚度。而以三酸甘油酯為於礎的胰島素抗性指數是年輕族群的頸動脈內膜中層厚度較佳預測工具，可取代胰島素抗性代謝評分(METS-IR)。;Current studies have shown that left ventricular hypertrophy (LVH) and insulin resistance are associated with carotid intima-media thickness (cIMT), which is an indicator of hypertension and subclinical atherosclerosis in middle-aged and elderly people. However, in physically fit young adults, this association is unclear. There are no studies to clarify the association between left ventricular hypertrophy and atherosclerosis with ultrasound and electrocardiogram (ECG) in young adults. Therefore, this study aimed to examine the association between ECG, cardiac ultrasound parameters and various insulin resistance indices with subclinical atherosclerosis assessed by carotid intima-media thickness (cIMT) in young adults of the Taiwan Army. A total of 1822 Taiwanese military adults free of diabetes, aged 18 40 years, received an annual health examination including electrocardiography (ECG) and echocardiography in 2018–2020. Left carotid bulb cIMT was measured by high resolution ultrasonography. nIIR indices were assessed by TG concentrations, the TyG index, the TG/high-density lipoprotein cholesterol (HDL-C) ratio, and the metabolic score for IR (METS-IR). Multiple logistic regression analysis was used to determine the associations between echocardiographic and ECG parameters. Multivariable linear regression analyses were used to determine the associations between nIIR indices. ECG-based LVH, RVH and heart rate ≥75/min were associated with cIMT ≥0.8 mm, while echocardiographic LVH was inversely associated with cIMT ≥0.8 mm. In the overall participants, there was an association between cIMT and TG. Higher physical fitness may cause cardiac muscle hypertrophy and reduce the atherosclerosis severity, possibly leading to the paradoxical echocardiographic finding. This study suggests that ECG-based LVH remains a good marker of subclinical atherosclerosis in our military population. This study also highlights that some nIIR indices could be used to assess cIMT in young adults, particularly for those with obesity and those without hyperuricemia. The TG-based indices instead of the novel marker, METS-IR, are suggestive as stronger predictors of greater cIMT in young adults.
