超声评价2型糖尿病患者心脏-血管耦联关系

Echocardiography for assessing ventricular-arterial coupling in patients with type 2 diabetes mellitus

目的探讨超声评价2型糖尿病患者心脏-血管耦联关系的临床价值。方法 2型糖尿病患者63例,根据左心室射血分数分为左心室收缩功能正常组(A组)45例与心功能衰竭组(B组)18例,同期健康体检者30例为对照组。测量3组左侧肱动脉压,获取左心室结构、功能及血流动力学参数,计算左心室壁相对厚度、心肌耗氧参数心率血压二重乘积及有效动脉弹性。采用多元线性逐步回归,筛选耦联参数有效动脉弹性的独立关联指标。结果 A,B组心率血压二重乘积较对照组增高(P<0.01);A,B组左心室收缩末压、心率血压二重乘积比较差异有统计学意义(P<0.01);3组左心室壁相对厚度、左心室质量指数、左心室射血分数、有效动脉弹性、高密度脂蛋白胆固醇及血糖比较差异均有统计学意义(P<0.01);进入方程的变量有左心室射血分数、血糖、左心室壁相对厚度、高密度脂蛋白胆固醇和心率血压二重乘积,其标准回归系数的绝对值依次减低,分别为0.471,-0.333,0.236,-0.166和0.133。结论 2型糖尿病患者心脏-血管存在耦联关系,并与生化指标及心肌耗氧参数密切相关。

Objective To investigate the clinical value of echocardiography to ventricular-arterial coupling in patients with type 2 diabetes mellitus（T2DM）.Methods Sixty-three patients were divided into 45 T2DM patients with normal heart function（group A）,and 18 T2DM patients with heart failure（group B） according to left ventricular ejection fraction（LVEF）,and another 35 healthy subjects were as controls（control group）.The brachial artery pressure was measured to obtain left ventricular structure and function as well as the dynamical parameters for calculating the relative thickness of left ventricle,myocardial oxygen consumption index,rate-pressure product,and arterial elastance index in three groups.The indicators associated with Ea were selected by multiple linear stepwise regression analysis.Results Rate-pressure product was significantly higher in groups A and B than that in control group（P0.01）,while there were significant differences in left ventricular end-systolic pressure and rate-pressure product between group A and group B（P0.01）.Left ventricular relative thickness,LVEF,elastance index,high density lipoprotein cholesterol and plasma glucose were significantly different among these three groups（P0.01）.Analysis of multiple variables pair-logistic regression showed that LVEF,plasma glucose,left ventricular relative thickness,high density lipoprotein and rate-pressure product were the main variables associated with elastance index and the absolute value of coefficients were 0.471,-0.333,0.236,-0.166 and 0.133.Conclusion The ventricular-arterial coupling plays a very significant role in the progress of T2DM,and is closely correlated with blood biochemical indicators and myocardial oxygen consumption index.