二甲双胍对2型糖尿病患者血压昼夜节律及左室舒张功能的影响

The Effect of Metformin to Blood Pressure Circadian Rhythm and Left Ventricular Diastolic Function in Type 2 Diabetes

目的:研究2型糖尿病(T2DM)伴高血压患者血压昼夜节律和左室舒张功能的特点及二甲双胍对二者的影响。方法:对73例2型糖尿病高血压患者(DM组),72例非糖尿病高血压患者(HT组)和50例健康对照组(NC组)分别进行24h动态血压监测和超声心动图检查,同时检测体重指数(BMI)、空腹血糖(FPG)、空腹胰岛素(FINS)等,观察糖尿病患者血压昼夜节律和左室舒张功能的特点及二甲双胍对二者的影响。结果:DM组和HT组白昼收缩压(DSBP)、白昼舒张压(DDBP)、夜间舒张压(NDBP)无统计学差异。而DM组左室舒张功能差于HT组,且夜间收缩压(NSBP)水平高于HT组。DM组代表左室舒张功能的舒张早期和舒张晚期心室最大充盈速度的比值(E/A)与NSBP和胰岛素敏感指数(ISI)呈负相关(r=-0.57,r=-0.49P<0.05)。多元回归显示,胰岛素敏感性降低为左室舒张功能减低的独立预测因素。DM组口服二甲双胍0.5g,3次/d,3个月后,NSBP显著下降(P<0.05),E/A增高,但较服药前无显著统计学差异(P>0.05)。结论:高血压伴糖尿病患者与单纯高血压患者相比夜间收缩压显著增高,左室舒张功能显著降低,胰岛素敏感性降低为左室舒张功能减低的独立预测因素。二甲双胍能改善T2DM患者的胰岛素敏感性,降低NSBP并有可能改善左室舒张功能。

Objective：To study the effect of metformin to blood pressure circadian rhythm and left ventricular diastolic function（LVDF）in type 2 diabetes.Methods：73 cases of diabetes with high blood pressure（group DM）,72 cases of hypertension（group HT）and 50 cases of normal control group（group NC） were performed with 24h ambulatory blood pressure monitoring and echocardiography.The body mass index（BMI）,fasting plasma glucose（FPG）,fasting insulin（FINS）were detected.And the effect of metformin to blood pressure circadian rhythm and LVDF were observed.Results：There were no statistic difference in daytime systolic blood pressure（DSBP）,daytime diastolic blood pressure（DDBP） and noctem diastolic blood pressure（NDBP）between group DM and group HT,but the left ventricular diastolic function were lower and the nocte systolic blood pressure（NSBP）were higher in group DM than in HT.The E/A were negative correlation with NSBP and insulin sensitivity index（ISI）（r=0.57,r=0.49,P0.05）,multiple regression indicate that the depress of ISI was the independent predict factor of left ventricular diastolic function degrade.After 3 months of taking metformin,NSBP decreased significantly（P0.05）,and E/A increased but no significant statistic difference（P0.05）.Conclusion：Compared with simple hypertension patients,the NSBP increases and the left ventricular diastolic function decreases significantly in diabetes with high blood pressure patients.The depress of ISI is the independent predict factor of left ventricular diastolic function degrade.Metformin can improve insulin sensitivity and might improve LVDF in type 2 diabetes.