降糖速率对2型糖尿病合并冠心病患者左心收缩功能影响

Influence of the glucose-lowering rate on left ventricular systolic function in patients with type 2 diabetes and coronary heart disease

目的 研究降糖速率对2型糖尿病（2-DM）合并冠心病（CHD）患者左心收缩功能变化的影响.方法 对65例2-DM者和58例2-DM合并CHD患者强化降糖治疗,分析不同降糖速率下左心室射血分数（LVEF）、左室短轴缩短率（LVFS）、二尖瓣环收缩期运动峰值速度（Sm）和收缩期二尖瓣瓣环下移距离（MAD）的变化.结果 强化降糖后,随访3个月时,2组LVEF、LVFS、Sm、MAD均较前明显增加.进一步将2-DM合并CHD,以≤2.0、2.1~4.0、4.1~6.0、〉6 mmol/（L·d）的降糖速率,分为4个亚组（2-DM＋CHD 1,2-DM＋CHD 2,2-DM＋CHD 3,2-DM＋CHD 4）.2-DM＋CHD 1组和2-DM＋CHD 2治疗后LVEF、LVFS、Sm、MAD较治疗前无明显差异,而2-DM＋CHD 3,2-DM＋CHD 4组则明显下降,随访时亚组间LVEF、LVFS、Sm、MAD差异无统计学意义（P〉0.05）.结论 2-DM合并CHD患者降糖速率过快会短期导致左心收缩功能受损;血糖长期控制良好则会改善左心收缩功能.

Objective To evaluate the influence of glucose - lowering rate on left systolic ventricular function in patients with type 2 diabetes mellitus（T2DM） and coronary heart disease（CHD）. Methods A total of 65 cases of DM and 65 cases of T2DM - CHD received intensive glucose therapy. After measuring left ventricular ejection fraction （ LVEF）, the left ventricular fractional shortening（ LVFS）, mitral annulus systolic peak velocity （Sm） and the distance down the systolic mitral annular（ MAD）, variations and correlation factors were evalua- ted. Results During the three - month follow - up time, LVEF, LVFS, Sm and MAD were significantly higher than those before intensive therapy in both groups. LVEF, LVFS, Sm and MAD were significantly lower than those before intensive therapy in T2DM - CHD group with a glucose - lowering rate 〉 4 mmoL/L ~ d, whereas at the end of follow - up, there were no significant difference among subgroups. Conclu- sion For patients with T2DM and CHD, an excessively fast glucose - lowering rate could impair left ventricular systolic function. Long - term, good control of blood glucose could improve left ventricular diastolic function.