2型糖尿病患者心脏功能与胰岛素抵抗关系的研究

Relationship between cardiac function and insulin resistance in T2DM patients

目的探讨住院T2DM患者心脏功能和IR的关系并明确影响其变化的危险因素。方法选取338例伴或不伴高血压(EH)T2DM患者,应用心脏多普勒超声观察心脏结构及功能的变化,研究左室射血分数(LVEF)、二尖瓣心室充盈早期血流速度峰值(E峰)、晚期心室充盈心房收缩血流速度峰值(A峰)的比值(E/A)与患者年龄、病程、BMI、HbA1c、TG、HDL-C、LDL-C及胰岛素抵抗指数(HOMA2-IR)的相互关系,以及影响其变化的危险因素。结果 LVEF在伴或不伴EH患者间及不同EH分级间比较差异有统计学意义(P<0.01)。在不伴EH(NEH)组中,LVEF仅与HOMA2-IR相关(r=-1.898,P=0.028)。对于E/A值,年龄、EH、HOMA2-IR是其独立危险因素(OR分别为1.059、4.079、3.403,P均<0.01)。结论 IR可作为独立危险因素作用于心脏功能。

Objective To investigate the relationship between cardiac function and IR, and find out risk factors for cardiac function in T2DM patients. Methods From November 2010 to April 2011, 338 T2DM patients with or without essential hypertension （EH） in our hospital were enrolled in this study. Doppler echocardiography was used to evaluate the changes of cardiac structure and function. Left ventricular ejection fraction （LVEF）, mitral peak early diastolic transmitral flow velocity （E）, mitral peak late diastolic transmitral flow velocity （A）, E/A ratio were measured. Patients＇ age and course of disease were recorded. The BMI, HbAlc, TG, HDL-C, LDL-C, and homeostasis model assessment2-IR （HOMA2-IR） were measured to investigate the relationship of them with IR and find out risk factors for cardiac function in T2DM patients. Results Significant difference in LVEF was found in T2DM patients with or without EH and with EH in different degrees （P（0. 01）. In those without EH, LVEF was only correlated with HOMA2-IR （r=-1. 898, P=0. 028）. As for E/A, the age, EH, and HOMA2-IR were the risk factors in T2DM patients （OR=1. 059, 4. 079, and 3. 403 respectively, P〈0. 01）. Conclusion IR could be an independent factor affecting on the changes of the cardiac function. Patients with IR predispose to present cardiac functional insufficiency.