二甲双胍对原发性高血压患者左心室肥厚的影响

Effects of Metformin on Left Ventricular Hypertrophy in Patients with Primary Hypertension

【目的】探讨口服降糖药二甲双胍对高血压患者左心室肥厚(LVH)的影响。【方法】分析307例原发性高血压患者的临床及超声心动图检查资料,其中高血压合并糖尿病且服用二甲双胍治疗6月以上者110例(A组),高血压合并糖尿病未服用二甲双胍治疗者97例(B组),单纯高血压组100例(C组)。【结果】3组之间一般临床资料包括年龄、性别、体质量指数、病程、血压水平、血脂、肾功能、主要用药情况等无明显差别;A组和B组空腹血糖水平明显高于C组,而A组和B组之间空腹血糖及糖化血红蛋白(HbAIc)水平无明显差异。各组左心室舒张末期内径(LVEDd)及左心室收缩功能(射血份数,EF)无明显差异,与B组及C组相比,A组患者室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室质量指数(LVMI)明显降低(P<0.05);LVH发生率分别降低41.6%及34.4%(P<0.05);E/A比值明显减小,舒张功能不全(E/A比值<1)发生率明显下降(P<0.05)。【结论】二甲双胍可能改善了高血压患者左心室重构,减轻心肌肥厚,改善左心室舒张功能不全。值得进行前瞻性、随机对照的临床研究进一步明确这种效应。

[Objective] We aimed to observe the effects of metformin, an antihyperglycaemic drug, on left ventricular hypertrophy in patients with primary hypertension. [Methods] We retrospectively analyzed the clinical and echocardiographic data of 307 patients with primary hypertension admitted to our hospital from 2006 to 2008. These patients were classified into three groups： patients with primary hypertension and type 2 diabetes mellitus who used mefformin in their remedies for at least six months until this investigation （group A, n = 110）; patients with primary hypertension and type 2 diabetes mellitus who never used mctformin （group B, n = 97）, and patients with isolated primary hypertension without diabetes （group C, n = 100）. [Results] The general data including age, sex, body mass index, duration of hypertension or diabetes, blood pressure level, lipid profile, renal function and main drug used were comparable among the three groups. The fast plasma glucose of patients in group A and group B was significantly higher than that in group C, while the blood glucose and hemoglobin Alc were not different between group A and group B. The left ventricle end-diastolic dimension （LVEDd） and systolic function, expressed as ejection fraction （EF）, were not different between the three groups. Compared with group B and group C, patients in group A had lesser interventricular septum thickness （IVST）, left ventricular posterior wall thickness （LVPWT） and left ventricular mass index （LVMI） （P 〈 0.05） and the incidence of left ventricular hypertrophy decreased 41.6% and 34.4% respeetively（P 〈 0.05）. TheE/ A ratio of patients in group A （1.5 ± 0.8） was greater than that in group B （1.2 ± 0.9） and group C （1.2 ± 0.7） （P 〈 0.05） and the incidence of diastolic dysfunction, defined as E/A ratio less than 1.0, was lower in group A （25%） than in group B （42%） and group C （41%） （P 〈 0.05）. [Conclusion] Metformin may attenuate left ventricular hypertrophy and improve left ventricular diastolic dysfunction in patients with hypertension and type 2 diabetes mellitus. Further prospective, randomized and controlled clinical trial is warranted to confirm these beneficial effects of mefformin on hypertensive left ventricle hypertrophy.