2型糖尿病合并心功能不全患者脂联素及抵抗素水平的改变及其临床意义

Clinical study on adiponectin and resistin levels in T2DM patients with heart failure

目的探讨T2DM合并心功能不全患者APN及抵抗素水平改变的临床意义。方法96例T2DM患者分为新诊断T2DM组33例,T2DM＋心功能Ⅰ~Ⅱ级组32例和T2DM＋心功能Ⅲ~Ⅳ级组31例。另选健康体检者35名（NC组）。比较各组FPG、FIns、脑钠肽（BNP）、APN、抵抗素水平。心脏彩色多普勒测定左室射血分数（LVEF）、二尖瓣口舒张早期流速峰值E峰/舒张晚期流速峰值A峰（E/A）、舒张早期波e峰/舒张晚期波a峰（e/a）、峰值肺静脉血流收缩期S波/峰值肺静脉舒张早中期D波（S/D）。结果 T2DM各组糖尿病病程、BMI、WC、HbA1c、抵抗素较NC组升高,APN较NC组降低。T2DM＋心功能Ⅲ~Ⅳ级组E/A、LVEF、APN较其他组低（P〈0.05）,抵抗素水平较其他组高（P〈0.05）。T2DM＋心功能Ⅰ-Ⅱ级组和T2DM＋心功能Ⅲ-Ⅳ级组e/a、S/D较其他组低（P〈0.05）。心脏彩色多普勒显示,T2DM各组E/A、e/a、S/D、LVEF较NC组下降（P〈0.05）。结论随着T2DM病程延长及心功能逐渐衰竭,APN、抵抗素水平及心肌舒张顺应性减低和收缩力下降。

Objective To investigate the clinical value of APN and resistin levels in T2 DM patients with heart failure. Methods A total of 96 T2 DM patients and 35 healthy subjects were selected and divided into four groups：newly-diagnosed T2 DM group（T2DM group,n=33）,T2 DM with cardiac functionⅠ - Ⅱgrade group（T2DM＋cardiac functionⅠ - Ⅱ grade group,n=32）,T2 DM with cardiac function Ⅲ-Ⅳ grade group（T2DM＋cardiac function Ⅲ - Ⅳ grade group,n=31）and normal control group（NC group,n=35）.Serum FPG,FIns,brain natriuretic peptide（BNP）,APN and resistin were measured and compared among four groups.The left ventricular ejection fraction（LVEF）,the ratios of mitral early diastolic peak filling velocity toadvanced diastolic peak filling velocity（E/A）,early diastolic wave creste to advanced diastolic wave crest a（e/a）and pulmonary venous flow systolic S wave peak valueto early-to-middiastolic D wave peak value（S/D）were calcuatedby color doppler echo cardiography in all subjects. Results Duration of DM,BMI,WC,HbA1 c and resistin were higher but APN was lower in DM groups than in NC group.APN,E/A and LVEF were significantly lower but resistin level was significantly higher in T2DM＋cardiac function Ⅲ-Ⅳ grade group than in the other groups（P〈0.05）.e/a and S/D were significantly lower in T2DM＋cardiac functionⅠ-Ⅱ grade group and T2DM＋cardiac function Ⅲ - Ⅳ grade group than in other groups（P〈0.05）.Color doppler echocardiography results showed that E/A,e/a,S/D and LVEF were all significantly lower in T2 DM groups than in NC group（P〈0.05）. Conclusion APN and resistin level decreased,and myocardial systolic and diastolic function declined with the progression of T2 DM and aggravation of heart failure.