脑钠肽与超声心动图评价老年糖尿病并存高血压患者左心室舒张功能的研究

Assessment of left ventricular diastolic function by brain natriuretic peptide and tissue doppler imaging in the elderly patients with diabetes mellitus and hypertension

目的 探讨老年糖尿病并存高血压患者左心室功能的变化与脑钠肽（BNP）水平的关系. 方法 128例2型糖尿病患者按是否并存高血压分组,其中不伴高血压组63例,伴高血压组65例,对照组为62例健康查体者.测定各组BNP浓度.常规超声测定左心室结构指标,计算左心室质量指数（LVMI）,脉冲多普勒测量二尖瓣口舒张早期血流速度（E）、舒张晚期血流速度（A）,计算E/A值.定量组织多普勒技术（QTVI）测量左心室壁二尖瓣环6个位点（侧壁和后间隔、前壁和下壁、前间隔和后壁）处的舒张早期峰值运动速度（Em）和舒张晚期峰值运动速度（Am）.计算6个位点平均Em、Am（MEm、MAm）和E/MEm比值. 结果 糖尿病不伴高血压组、伴高血压组LVMI[分别为（91.6±17.3）g/m2、（116.7±20.5）g/m2]、E/MEm（10.3±1.8和12.5±1.4）及BNP浓度[（47.7±29.4）ng/L、（105.7±32.5）ng/L]较对照组[分别为（78.7±19.5）g/m2、8.9±1.6、（20.8±11.63）ng/L]升高,差异有统计学意义（F值分别为11.54、13.83和9.75,P均＜0.05）；不伴高血压组、伴高血压组MEm[《6.7±1.0）cm/s、（5.4±0.9）cm/s]较对照组[（5.4±0.9）cm/s]降低,差异有统计学意义（F=11.26,P＜0.05）.糖尿病患者BNP浓度与E/A、MEm值呈负相关（r值分别为-0.42、-0.51,均P＜0.01）,与LVMI和E/MEm值呈正相关（r值分别为0.48、0.58,均P＜0.01）. 结论 糖尿病患者左心室舒张功能降低,并存高血压患者左心室舒张功能障碍更为严重.联合血浆BNP浓度和超声指标有助于准确评估老年糖尿病患者左心室舒张功能.

Objective To investigate the correlation between brain natriuretic peptide（BNP）and left ventricular diastolic function in the elderly patients with diabetes mellitus and hypertension.Methods 128 elderly patients with diabetes mellitus were divided into diabetes without hypertension （n=63）and with hypertension（n=65）,and other 62 normal subjects were selected as control group.Plasma BNP levels and indexes of echocardiography,including left ventricular mass index（LVMI）,the mitral peak flow velocity during early（E）and late diastole（A）,ratio of E/A,average peak velocities at mitral annuluses of six sites in left ventricular wall during early（MEm）and late diastole （MAm）,and relative E/MEm were measured in all patients.Results LVMI,E/MEm and the levels of BNP were significantly higher in groups of diabetes without and with hypertension[（91.6 ±17.3）g/m2 and（116.7±20.5）g/m2,（10.3±1.8）and（12.5±1.4）,（47.7±29.4）ng/L and（105.7±32.5）ng/L]than in control group[（78.7±19.5）g/m2,（8.9± 1.6）and（20.8±11.63）ng/L,respectively]（F=11.54,13.83 and 9.75,all P〈0.05）,while MEm in two diabetes groups[（6.8±1.0）and（5.4±0.9）cm/s]were decreased as compared with control group[（8.0± 1.1）cm/s,F=11.26,P〈0.05].The BNP levels were negatively correlated with E/A and MEm（r =-0.42 and -0.51,all P〈0.01）,and positively correlated with LVMI and E/MEm（r=0.48 and 0.58,all P〈0.01）.Conclusions Left ventricular diastolic function is impaired in diabetes mellitus and more severely impaired in diabetic patients with hypertension.A combination of plasma BNP and echocardiography parameter may be helpful to accurately evaluate left ventricular diastolic function in the elderly patients with diabetes mellitus and hypertension.