二甲双胍对高血压合并2型糖尿病患者心室重塑的影响

Effect of metformin on ventricular remodeling in patients with primary hypertension and type 2 diabetes mellitus

目的探讨二甲双胍对高血压合并2型糖尿病患者心室重塑的影响以及高血压病程和用药时长对二甲双胍心脏作用的影响。方法本回顾性研究人选了2012年1至12月在北京大学第三医院心血管内科住院的高血压合并2型糖尿病患者176例，临床随访6～24个月（中位随访11个月），分别记录患者基线和随访期两次临床资料及超声心动图结果，仅有基线资料者未纳入本研究。按照患者在随访期内是否服用二甲双胍分为二甲双胍组（84例）和对照组（92例）。再对总体人群进行亚组分析，评价高血压病程和用药时长对二甲双胍心脏作用的影响。结果二甲双胍组基线室间隔厚度（IVSD）、左室后壁厚度（LVPWD）及左室质量指数（LVMI）与对照组差异均无统计学意义（均P〉0．05）。随访期二甲双胍组IVSD（P=0．001）、LVPWD（P=0．04）、LVMI（p=0．01）均显著低于对照组。经多因素校正后，服用二甲双胍仍是患者LVPWD（P=0．02）和LVMI（P=0．04）的独立影响因素。服用二甲双胍〈1年和≥1年的患者LVMI均低于对照组，但服用二甲双胍≥1年者与对照组比较差异有统计学意义（P=0．04）。病程≥5年的患者，随访期二甲双胍组IVSD（P=0．01）和LVMI（P=0．02）均显著低于对照组。结论二甲双胍可抑制高血压合并2型糖尿病患者心肌肥厚程度，对于高血压病程较长和服用二甲双胍时间更长者抑制作用可能更为明显。

Objective To explore the effects of metformin on left ventricular remodeling in patients with primary hypertension and type 2 diabetes mellitus, and to investigate the effects of hypertension duration and duration of drug administration on metformin＇ s cardiac action. Methods The clinical and echocardiographic data of 176 patients with primary hypertension and type 2 diabetes mellitus who were admitted to department of cardiology from January to December 2012 were retrospectively analyzed. The follow-up period was 6 to 24 months （ the median follow-up time was 11 months ） . The patients were classified into two groups according to the usage of metformin ： metformin group （ n = 84 ） and control group （n = 92）. The clinical data and echoeardiography findings were evaluated both at baseline and follow-up. Subgroup analyses were used to assess the effects of hypertension duration and duration of drug medication on metfomin＇s action. Results At baseline, there was no significant difference in interventrieular septum depth （IVSD） , left ventrieular posterior wall depth （LVPWD） , and left ventrieular mass index （LVMI） between the two groups. At the follow-up period, IVSD （P =0. 001 ）, LVPWD （P =0. 04） and LVMI （P =0.01 ） were lower in metformin group. Multiple linear regression indicated that mefformin had significant influence on LVPWD （P = 0. 02） and LVMI （P = 0. 04）. At the follow-up period, LVMI was lower in two metformin subgroups. Additionally, LVMI was lower in the group which the patients took mefformin for more than one year than that in control group （ P = 0. 04 ）. For patients whose hypertension duration was not shorter than5 years, IVSD （P =0. 01 ） and LVMI （P = 0. 02） were lower in metformin group at the follow-up period, compared with control group. Conclusions Metformin may attenuate hypertrophy of left ventricular in patients with primary hypertension and type 2 diabetes mellitus. In patients with longer hypertension duration and longer duration of metformin use, mefformin may show more obvious effects.