老年早期糖尿病肾脏疾病患者左心室舒张功能不全的相关因素分析

Related factors of left ventricular diastolic dysfunction in elderly patients with early diabetic kidney disease

目的：探讨影响老年早期糖尿病肾脏疾病（diabetic kidney disease,DKD）患者左心室舒张功能的相关因素。方法选取老年早期 DKD 患者89例,组织多普勒测定心脏舒张功能,分为左心室舒张功能不全组及左心室舒张功能正常组。分析2组患者临床特点以及血 pH 值、血红蛋白（he-moglobin,Hb）、糖化血红蛋白浓度、尿素氮、血肌酐、尿酸、血钙、血磷、N 末端 B 型利钠肽原（N termi-nal B type natriuretic peptide,NT-proBNP）、甲状旁腺素等的差异。引入多因素非条件 Logistic 回归分析,探讨左心室舒张功能不全的独立危险因素,并对相关因素进行 ROC 曲线分析。结果89例老年早期 DKD 患者中,66例存在左心室舒张功能不全,发生率为74.2%。左心室舒张功能不全组与左心室舒张功能正常组,年龄为[（72.6±5.0）岁比（68.9±5.5）岁,P 〈0.01]；糖尿病病程为[（10.9±3.2）年比（7.5±2.5）年,P 〈0.01]；估算肾小球滤过率（estimated glomerular filtration rate,eGFR）值为[（55.8±17.2）ml·min^-1·（1.73 m^2）^-1比（66.1±15.9）ml·min^-1·（1.73 m^2）^-1,P 〈0.05]；Hb 为[（111.2±15.1）g/L 比（124.3±18.4）g/L,P 〈0.01]；血钙为[（8.75±0.84）mmol/L 比（9.68±0.78）mmol/L,P 〈0.01]；血磷为[（4.12±0.41）mmol/L 比（3.80±0.49）mmol/L,P 〈0.01]；NT-proBNP 为[（269.5±46.8）ng/L 比（222.3±45.3）ng/L,P 〈0.01]。多因素非条件 Logistic 回归分析显示,年龄和低钙血症是左心室舒张功能不全的独立危险因素（年龄：OR=2.405,95% CI=1.789～3.460,P 〈0.05；低钙血症：OR=2.961,95% CI=2.321～3.951,P 〈0.01）。ROC 曲线分析显示低钙血症和 NT-proBNP 对左心室舒张功能不全有诊断价值。结论老年早期 DKD 患者普遍存在左心室舒张功能不全,低钙血症程度与左心室舒张功能不全之间有相关关系,并且是左心室舒张功能不全的独立预测因素。

Objective To investigate and analyze the related factors of left ventricular diastolic function in elderly patients with early diabetic kidney disease （DKD）.Methods The study group con-sisted of 89 elderly patients with early DKD.Standard echocardiography was performed in all patients with tissue Doppler echocardiography for the evaluation of early （E）and late （A）transmitral veloci-ties.Patients were divided into two groups according to the results of E/A：group with LV diastolic dysfunction （E/A〈1）[DF （＋）]and group with normal LV diastolic function [DF （-）]when E/A≥1 .Clinical manifestations and the laboratory parameters [serum creatinine concentration,and the levels of urea,P,Ca,parathormone,platelet count,hemoglobin level,and N-terminal pro-B-type na-triuretic peptide（NT-proBNP）levels]were compared between two groups.Different parameters were analyzed by multivariate Logistic regression.Diagnostic value of related factors in left ventricular dias-tolic dysfunction was analyzed by ROC curve.Results Sixty-six（74.2%）patients had left ventricular diastolic dysfunction.Age,duration of diabetes,estimated glomerular filtration rate,serum calcium and NT-proBNP were statistically different between two groups[group with LV diastolic dysfunction VS.group with normal LV diastolic function,age：（72.6 ±5.0）years VS.（68.9 ± 5.5 ）years,P 〈0.01 ;duration of diabetes：（10.9 ± 3.2）years VS.（7.5 ± 2.5 ）years,P 〈 0.01 ;eGFR：（55.8 ± 1 7.2）ml·min^-1·（1 .73 m^2 ）^-1 VS.（66.1 ± 1 5.9）ml·min^-1·（1 .73 m^2 ）^-1 ,P 〈0.05;Hb：（1 1 1 .2 ± 1 5.1）g/L VS.（124.3±1 8.4）g/L,P 〈0.01 ;serum Ca：（8.75 ±0.84）mmol/L VS.（9.68 ±0.78） mmol/L,P 〈0.01 ;serum P：（4.12 ± 0.41 ）mmol/L VS.（3.80 ± 0.49）mmol/L,P 〈 0.01 ;NT-proBNP：（269.5±46.8）ng/L VS.（222.3 ±45.3）ng/L,P 〈0.01 ].Multivariate Logistic regression analysis showed that age and hypocalcemia were independent risk factors for left ventricular diastolic dysfunction（age：OR=2.405,95% CI= 1 .789～3.460,P 〈0.05;hypocalcemia：OR=2.961 ,95%CI=2.321 ～3.95 1 ,P 〈0.01）.ROC curve analysis showed hypocalcemia and NT-proBNP had diag-nostic value in left ventricular diastolic dysfunction.Conclusions Hypocalcemia extent in elderly pa-tients with early DKD was related to left ventricular diastolic dysfunction,and is independent predictor of left ventricular diastolic dysfunction.