代谢综合征早期肾功能损害与心室重构的关系

Mild renal dysfunction and its association with left ventricular remodeling in patients with metabolic syndrome

目的探讨代谢综合征早期肾功能损害对左室重构的影响。方法337例住院患者分为高血压(EH)组91例,糖尿病(T2DM)组64例和代谢综合征(MS)组182例,根据尿微量白蛋白水平将以上患者分别分为肾功能正常组和早期肾功能损害组,比较左室结构的变化和左室肥厚的发生率。结果①MS组内,早期肾功能损害的舒张期末左室内径(LV)、舒张期末左室后壁厚度(LVPW)、舒张期末室间隔厚度(IVS)、左室质量(LVM)和左室质量指数(LVMI)与肾功能正常组比较明显升高,其中LV(44±6)mm vs(41±5)mm、LVPW(10.9±2.0)mm vs(9.9±1.5)mmI、VS(10.2±2.9)mm vs(9.3±1.2)mm、LVM(161±4)g vs(134±4)g和LVMI 48±1 vs 37±1,差异均有统计学意义(均P<0.05);EH组内,早期肾功能损害的LV、LVPWI、VS、LVM和LVMI与肾功能正常组比较明显升高,其数值分别为(44±4)mm vs(41±5)mm(、10.8±1.9)mm vs(9.9±1.6)mm(、11.0±1.6)mm vs(9.4±1.6)mm(、160±6)g vs(129±4)g和(46±2)vs(35±1),差异有统计学意义(均P<0.05);T2DM组内,早期肾功能损害的LVPW、LVM和LVMI与肾功能正常组比较明显升高,其数值分别为(9.1±1.2)mm vs(8.5±1.0)mm、(158±2)g vs(113±5)g和43±2 vs 30±1,差异均有统计学意义(均P<0.05)。②早期肾功损害的MS、T2DM和EH病人罹患左室肥厚(LVH)分别为33.6%、10.0%和17.7%,而肾功能正常的MS和EH病人罹患LVH分别为16.0%和4.3%;本组资料中肾功正常的DM患者无罹患LVH。结论代谢综合征患者早期肾功能损害对左室重构有显著影响,对代谢综合征患者积极预防早期肾功能损害能减少左室重构的发生。

Objective To investigate the effects of mild renal dysfunction and left ventricular remodeling in the patients with metabolic syndrome（MS）. Methods 337 in-patients were categorized,according to the diseases they were suffering from into essential hypertension group （EH, 91 cases）, type 2 diabetes mellitus group （T2DM,64 cases）,and MS group（MS, 182 cases）. The difference on left ventricular structure and the prevalence of left ventricular hypertrophy （LVH） were compared between mild renal dysfunction group and normal renal function group. Results In the patients with MS, the value of LV, IVS, LVPW, LVM, LVMI in groups of mild renal dysfunction increased significantly compared with that in group of normal renal function E （44± 6） mm vs （41± 5） mm, （10.9 ± 2.0） mm vs （ 9.9 ± 1.5） mm,（10.2±2.9） mm vs （9.3±1.2） mm,（161±4） g vs （134±4）g and 48±1 vs 37±1] respectively;furthermore, among mild renal dysfunction groups of EH,T2DM and MS, the prevalence of LVH in the patients was 33.6%, 10.0 and 17.7%,while among normal renal function groups of MS and EH, the prevalence of LVH in the patients was 16.0% and 4.3%,no prevalence of LVH in was found those with normal renal function of T2DM. Conclusion Mild renal dysfunction is one of the important factors on left ventrieuIar remodeling in the patients with MS. If mild renal dysfunction patients with MS were early intervented,and left ventrieular remodeling could be decreased.