老年糖尿病患者急性心力衰竭血浆脂联素浓度变化及临床意义

Clinical significance and the changes of plasma adiponectin in old diabetes patients with acute heart failure

目的研究老年糖尿病患者急性心力衰竭(AHF)时血浆脂联素(APN)浓度变化及临床意义。方法 135例观察对象,根据有无急性心力衰竭及糖尿病分为4组:非糖尿病心力衰竭组(A组)31例;糖尿病心力衰竭组(B组)43例,非糖尿病对照组(C组)30例,糖尿病对照组(D组)31例。入院即刻检测APN、NTproBNP,并行超声心动图检查,记录缓解时间及随访30d心血管事件发生情况,分析各组之间的差异及各指标间的相关性。结果 (1)AHF时,B组肺部啰音≥50%的患者发生率,下肢水肿发生比例、LgNTproBNP、治疗时间>24h比例、30d内心血管事件发生率明显高于A组(P<0.05);心脏射血分数(EF)值明显降低(P<0.01)。(2)A组、B组、C组、D组APN浓度分别为:(21.27±4.36)μg/L,(18.31±4.17)μg/L,(14.27±2.54)μg/L,(11.49±1.09)μg/L,各组间差异有统计学意义。(3)B组APN>18.31μg/L的患者中有66.7%治疗时间>24h,30d心血管事件发生率为61.5%。(4)AHF患者APN浓度与LgNTproBNP呈正相关(A组r=0.693,B组r=0.575,P均<0.01)。结论 (1)合并糖尿病的老年AHF患者心力衰竭程度重、治疗反应差,死亡率高,30d内心血管事件多发。(2)AHF患者血浆APN浓度明显升高,糖尿病患者APN代偿性升高能力受到抑制。

Objective To study the clinical significance and the changes of plasma adiponectin（APN）concentrations in old patients with diabetes during acute heart failure（AHF）.Methods 135 patients were divided into four groups by history of AHF and diabetes mellitus （DM）：AHF without DM （group A,n =31）,AHF with DM（group B,n =43）,Control group without DM（group C,n =30）,Control group with DM（group D,n =31）.APN,NTproBNP were analysed before treated and UCG were undertook in 24 h.Record the time of remission.A 30-day follow-up by phone to verify cardiovascular events.Analysis the differences between the group and the relationship of the data.Results （1） The range of moistrale,incidence of lower-extremity edema,NTproBNP in group Bsignificantly higher than group A （P 〈 0.05）.Time of remission in group B were longer,30-day cardiac events was higher than group A （P 〈 0.05）.（2） APN of group A,B,C,D were significantly different [（21.27 ± 4.36） μg/L,（18.31 ± 4.17） μg/L,（14.27 ± 2.54） μg/L,（11.49 ± 1.09） ag/L,respectively,P 〈 0.01].（3） In group B,66.7% patients with APN 〉 18.31 μg/L stay in hospital longer than 24 h,the incidence of 30-day cardiovascular events higher（P 〈 0.01）.（4） Plasma APN concentration was positively correlated with LgNTproBNP （r =0.693,0.575,P 〈 0.01）.Conclusions （1） In old AHF patients with DM,heart failure degree were heavier,combined with poor therapy effect,high-mortality,and high incidence of 30-day cardiovascular events.（2） APN level elevated with the degree of AHF.In patients with DM,ability of compensatory increase in APN were weaken.