2型糖尿病患者左心室功能变化的临床研究

Clinical study of left ventricular function changes in patients with type 2 diabetes mellitus

目的：探讨2型糖尿病（DM）对左心室功能的影响及其可能机制。方法：冠状动脉造影和左心室造影证实，有662例冠状动脉狭窄患者，分别按有无DM将其分为冠心病（CHD）合并DM（CHD＋DM）组及CHD组，测定各组左心室射血分数（LVEF）及左心室舒张末压（LVEDP），判断左心室收缩及舒张功能。结果：CHD＋DM组的LVEF值与CHD组无明显差异，根据LVEF〉50％、30％。的％和≤30％将心功能进一步分级后，CHD＋DM组与CHD组在不同心功能分级间亦无统计学差异。CHD＋DM组的LVEDP明显高于CHD组（P〈0．05）。结论：LVEDP是评估左心室舒张功能的敏感指标，CHD合并DM时比单纯CHD的心脏舒张功能受损更明显。产生机制与DM的胰岛素缺乏所致心肌能量代谢紊乱有关。此外，心肌细胞蛋白糖基化作用导致的氧化应激、细胞内Ca^2＋转运机制异常以及心脏局部肾素-血管紧张素系统（RAS）激活等均可损伤心肌的结构和功能。

Objective： To assess the changes of left ventricular function and the mechanisms in the patients with type 2 diabetes mellitus. Methods ： 662 eases of coronary stenosis confirmed by angiography and left ventriculargraphy were divided into two group： the group of coronary artery stenosis with diabetes mellitus （ group CHD ＋ DM ） and the group of coronary artery disease （ group CHD ）, according to their complication of diabetes mellitus or not. Systolic and diastolic functions of left ventricular were measured by left ventricular ejection fraction （ LVEF ） and left ventricular end diastolic pressure （ LVEDP ）. Results ： There was no statistically significant difference in LVEF between the two groups. There was also no significant difference in LVEF between two groups graded on LVEF 〉 50% , 30% -50 %, 〈 30%. But LVEDP was significantly higher in group CHD ＋ DM than those in group CHD. Conclusion： LVEDP is a sensitive index in estimating left ventficular diastolic functions. It is significantly damaged in cardiac diastolic functions in patients suffered from coronary artery disease with diabetes mellitus.