皮质醇增多症患者心脏舒张功能减退的临床特征分析

Clinical manifestations of cardiac diastolic dysfunction in patients with Cushing syndrome

目的探讨皮质醇增多症患者心脏舒张功能的心脏超声表现和临床特征。方法采用回顾性分析方法,收集30例明确诊断为皮质醇增多症患者的相关资料,包括超声心动图、心电图、血皮质醇浓度、24 h尿皮质醇浓度、血清肾素及醛固酮浓度等。以30例年龄、性别相匹配的原发性高血压患者为对照组收集同样的资料。结果皮质醇增多症组的血皮质醇,空腹血糖,糖化血红蛋白浓度明显高于对照组,差异有统计学意义(P<0.05)。两组血电解质,肾素醛固酮基础态激发态和尿香草扁桃酸、血胆固醇浓度比较,差异无统计学意义(P>0.05)。超声心动图发现皮质醇增多症组心脏舒张功能减退比例达63.3%(19/30),而对照组为40%(12/30);同时两组二尖瓣血流舒张早期血流峰值与瓣环运动峰值速度比值(E/E')及二尖瓣环运动峰值早期和晚期速度比值(E'/A')、室间隔厚度(interventricular septal thickness,IVS)比较,差异有统计学意义(P<0.05);两组左心室射血分数(left ventricular ejection fraction,LVEF),左心室后壁厚度(left ventricular posterior wall thickness,LVWP),左心房(left atrium,LA),左心室内径(left ventricular diameter,LVD)等比较,差异无统计学意义(P>0.05)。结论皮质醇增多症患者合并心脏舒张功能减退发生率较原发性高血压患者显著增高,这可能与高皮质醇浓度、糖脂代谢紊乱有一定关系。

Objectives To investigate the manifestations of cardiac diastolic function by cardiac ultrasound and the clinical signs and symptoms in patients with Cushing syndrome. Methods Retrospective method was used and 30 patients diagnosed as Cushing syndrome were enrolled from March 2003 to March 2015 in Guangdong General Hospital. Echocardiography, electrocardiogram （ECG）, serum concentration of cortisol, concentration of 24-hour urinary cortisol, serum concentrations of renin and aldosterone of the patients were collected. Meanwhile, 30 age-and-gender- matched patients with essential hypertension were selected as control group. Results Concentrations of cortisol, fasting blood glucose and glycosylated hemoglobin （HbAlc） in Cushing syndrome group were significantly higher than those in control group （P〈0.05）. At the same time, concentrations of blood electrolyte, renin-aldosterone in basic state and excited state, urinary vanillylmandelic acid and cholesterol in plasma were not significantly different between the two groups （P〉O.05）. There were 63.3% （19/30） patients suffered from cardiac diastolic dysfunction in Cushing syndrome group, and 40% （12/30） in control group, the difference was significant between the two groups （P〈0.05）. In addition, there were significant differences between the two groups in E＇/A＇, E/E＇ and interventricular septal thickness, but no significant differences were found in left ventricular ejection fraction, left ventrieular posterior wall thickness, left atrium and left ventrieular diameter（P〉0.05 ）. Conclusions In patients with Cushing syndrome, the incidence rate of cardiac diastolic dysfunction is higher than that in patients with essential hypertension, which can be associated with the high concentration of cortisol and the disorders of glucose and lipid metabolism.