老年糖尿病并存冠心病患者下肢动脉硬化与心功能的相关性

Study on the relationship between lower limb artherosclerosis and cardiac function in elderly patients with diabetes mellitus complicated with coronary heart disease

目的探讨老年糖尿病（DM）并存冠心病（CHD）患者下肢动脉硬化和心功能变化的干H天性。方法将441例老年患者分为CHD组117例、DM组42例、DM并行CHD组（DM＋CHD组）132例、尤DM与CHD的对照组150例。用全自动动脉硬化测最仪测定下肢动脉硬化相关指标：收缩压、舒张压、脉压、臂踝脉搏波传导速度（baPWV）、踝臂指数（ABI）、趾臂指数（TBI）。用多普勒超声心动仪测定心功能相关指标：左心房直径（LA）、左心窜后壁厚度（LVPW）、左心室短轴缩短率（FS）、左心室射血分数（EF）、EF斜率。结果DM＋CHD组的baPWV较DM组和对照组增加[分别为（2012±354）与（1849±467）、（1863±347）cm／s，均为P〈0．05]；DM＋CHD组ABI较其他3组降低[分别为（0．91±0．23）与（1．15±0．11）、（1．07±0．16）、（1．06±0．14）cm／s，均为P〈0．05]；TBI两两比较．差异有统计学意义（均为P〈0．05）。DM＋CHD组LA和LVPW与CHD组和DM组差异无统计学意义（P〉0．05），但较对照组增高（P〈0．05）；DM＋CHD组的FS和EF斜率较DM组和对照组降低（P〈0．05）；DM＋CHD组EF较其他3组降低（均为P〈0．05）。baPWV与FS、EF和EF斜率呈负相关（r分别为-0．112、-0．151、-0．275，均为P〈0．05）；ABI与FS、EF和EF斜率呈正相关（r分别0．150、0．186、0．260，均为P〈0．01）；TBI与LA和LVPW呈负相关（r分别0．158、-0．171，均为P〈0．01），与FS、EF和EF斜率正相关（r分别0．163、0．197、0．243，均为P〈0．01）。结论老年DM并存CHD患者下肢动脉硬化，心功能下降。baPWV、ABI、TBI的监测不仅直接反映了外周血管功能，同时与心功能密切相关．一定程度上反映了心功能的状况。叮为心血管疾病的早期检测和防治提供依据。

Objective To investigate the relationship between lower limb artherosclerosis and cardiac function in elderly patients with diabetes mellitus（DM）complicated with coronary heart disease （CHD）. Methods 441 cases of elderly patients were divided into four groups： the group withCHD （n= 117）,the group with DM（n= 42）, the group with DM compllicated with CHD（DM＋CHD,n= 132） ,the group without DM and CHD（NC,n=150）. Systolic blood pressure （SBP）, diastolic blood pressure（DBP）, pulse pressure（PP）, brachial-ankle pulse wave velocity（baPWV）, ankle-brachial index（ABI） and toe-brachial index（TBI） were measured by the auto survey artherosclerosis apparatus. Left ventricular posterior wall （LVPW）,left atrium （LA）, fractional shortening （FS）, ejection fraction（EF） and EF slope were measured by the two-dimensional echocardiography. Results The baPWV was significantly higher in DM＋CHD group than in DM group and NC group[（2012±354） cm/s vs （1849±467）cm/s,（1863±347） cm/s. P〈0.053. The ABl was significantly lower in DM＋ CHD group compared with NC,CHD and DM groups（0.91 ± 0.23 vs 1. 15 ± 0.11,1.07 ± 0.16 and 1.06±0. 14. all P〈0.05）. There were significant differences in TBI among four groups（all P〈0. 05）：NC group（0. 90±0.15）〉CHD group（0. 80±0.16）〉DM group（0.71 ±0. 17）〉DM＋CHD group（0. 62±0. 17）. The LA and the LVPW were significantly higher in DM＋CHD group than in NC group（P〈0. 05）. The FS and EF slopes were significantly lower in the DM＋CHD group than in DM group （ P〈0. 05） and NC group（P〈0.05）. The EF in DM＋CHD group was significantly lower than that in other three groups （P〈0.05）. BaPWV showed a strong negative association with FS,EF and EF slope（r：-0. 112,-0. 151,-0. 275. all P〈0.05）. ABI showed a strong positive association with FS,EF and EF slope（r：0. 150,0. 186,0. 260. all P〈0.01）,TBI was found to have strong negative association with LA and LVPW （ r： -0. 158,-0.171 ;all P 〈 0.01 ） and have strong positive association with FS,EF and EF slope（r：0. 163,0. 197,0. 243. all P〈0.01）. Conclusions The lower limb artheroselerosis is serious and cardiac function is significantly decreased in elderly patients with diabetes mellitus complicated with coronary heart disease. PWV,ABI and TBI are closely related with cardiac function and can reflect the state of cardiac function in some extent.