2型糖尿病合并不同程度非酒精性脂肪肝患者的左心收缩功能比较

Left ventricular systolic function in patients with type 2 diabetes combined with nonalcoholic fatty liver disease

目的探讨2型糖尿病合并不同程度非酒精性脂肪肝患者左心收缩功能。方法收集辽宁医学院附属第一医院内分泌科2015年3-8月门诊及住院符合入选条件的2型糖尿病200例,根据肝超声分为2型糖尿病未合并脂肪肝组(A组,94例)和2型糖尿病合并非酒精性脂肪肝组(B组,106例),B组按脂肪肝严重程度分级:轻度组(B1组,45例),中度组(B2组,31例),重度组(B3组,30例)。比较各组空腹血糖、三酰甘油、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、谷丙转氨酶(alanine transaminase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)、左心室舒张期内径(left ventricular diastolic diameter,LVDD)、左心室收缩期内径(left ventricular systolic diameter,LVSD)、每搏输出量(stroke volume,SV)、左心室射血分数(left ventricular ejection fraction,LVEF)、左心室短轴缩短率(left ventricular fractional shortening,LVFS)。结果 A、B两组的年龄、性别、病程差异无统计学意义(P>0.05),B组腰臀比、空腹血糖、三酰甘油、ALT、AST、LDL-C、LVDD、LVSD明显升高(P<0.05),而SV、LVEF、LVFS明显下降(P<0.05);与B1组比较,B2和B3组的腰臀比、空腹血糖、三酰甘油、ALT、AST、LDL-C、LVSD明显升高(P<0.05),SV、LVEF、LVFS明显下降(P<0.05);与B2组比较,B3组腰臀比、空腹血糖、三酰甘油、ALT、AST、LDL-C明显升高(P<0.05),SV、LVEF、LVFS明显下降(P<0.05)。结论随着非酒精性脂肪肝严重程度的增加,患者左心收缩功能明显下降。

Objective To investigate the correlation between degrees of nonalcoholic fatty liver disease（NAFLD） and left ventricular systolic function in patients with type 2 diabetes mellitus.Methods The study was performed in 200 patients with type 2 diabetes who underwent liver ultrasonography,echocardiography and blood test in the First Affiliated Hospital of Liaoning Medical University from March to August in 2015.All participants were divided into two groups：patients without ultrasound-diagnosed NAFLD（group A,n=94） and patients with ultrasound-diagnosed NAFLD（group B,n=106） according to the results of liver ultrasound.Then,patients in group B were graded as mild（group B1,n=45）,moderate（group B2,n=31）,and severe（group B3,n=30）.Information of fasting blood-glucose,triglyceride,low density lipoprotein cholesterol（LDL-C）,alanine transaminase（ALT）,aspartate aminotransferase（AST）,left ventricular diastolic diameter（LVDD）,left ventricular systolic diameter（LVSD）,stroke volume（SV）,left ventricular ejection fraction（LVEF）,left ventricular fractional shortening（LVFS） were collected and analyzed.Results Patients in group B were more likely to be overweight/obese and had higher level of fasting blood-glucose,triglyceride,ALT,AST,LDL-C,LVSD（P〈0.05） and lower level of SV,LVEF,LVFS（P〉0.01） than those in group A.The possibility of patients in group B1,B2 and B3 who were more likely to be overweight/obese and had higher level of fasting blood-glucose,triglyceride,ALT,AST,LDL-C（P〉0.05） and lower level of SV,LVEF,LVFS（P〉0.05） was group B3 group B2 group B1.Conclusion The severity of NAFLD is negatively correlated with left ventricular systolic function in patients with type 2 diabetes mellitus.