2型糖尿病患者心功能不全与胰岛素原、真胰岛素关系研究

Study on the Relationship between Cardiac Insufficiency and Proinsulin as well as Insulin in Patients with Type 2 Diabetes Mellitus

目的探讨2型糖尿病(T2DM)患者心功能不全的临床表现特点及相关激素的改变,寻找针对糖尿病心衰干预靶点。方法 T2DM患者90例、健康对照组35例,将患者按病程和症状分为:新诊断及病程<2年T2DM患者30例、病程>2年未发临床显性心衰症状和体征的T2DM患者32例、病程>2年且已发临床显性心衰症状和体征的T2DM患者28例、健康对照组35例。测空腹血糖(FPG)、胰岛素(FINS)、真胰岛素(TI)、胰岛素原(PI),注射胰岛素治疗患者测空腹C-肽,测定脑钠素(BNP)及采用心脏彩色多普勒测左室射血分数(LVEF)、二尖瓣口舒张早期流速峰值E峰/舒张晚期流速峰值A峰比值(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)以判定心脏功能。结果 1随着T2DM的进展,BNP明显增高;临床显性心衰组TI及PI与其余各组比较有明显的降低,组间差异有统计学意义(P<0.05);心脏彩超T2DM组较健康对照组E/A、e/a、S/D、LVEF有明显下降,差异有统计学意义(P<0.05)。结论随着T2DM的进展,真胰岛素、胰岛素原分泌水平减少与心肌舒张顺应性减低和收缩力下降成正相关,同时与心衰相关的激素:BNP分泌明显增加,提示胰岛素所介导的葡萄糖心脏低耗氧供能下降,使得心脏的泵功能发生因供能相关的代谢障碍,会影响和加重心衰。

Objective To investigate the clinical characteristics and related hormone changes of cardiac insufficiency in patients with type 2 diabetes mellitus（T2DM）,and to seek intervention targets for the treatment of heart failure in patients with di-abetes. Methods 90 cases of T2DM patients and 35 cases in healthy control group were included. According to courses of dis-ease and symptoms,the patients were divided as follows：30 cases of T2DM patients with recent diagnosis or disease courses shorter than 2 years,32 cases of T2DM patients with disease courses longer than 2 years but without clinically overt heart failure symptoms or signs,28 cases of T2DM patients with disease courses longer than 2 years who already had clinically overt heart failure symptoms or signs and healthy control group（n=35）. Fasting plasma glucose（FPG）,fasting insulin（FINS）,true insulin（TI） and proinsulin （ PI） were determined and as for patients receiving insulin injection treatment,fasting C-peptide was determined. Cardiac function was assessed by determination of brain natriuretic peptide（ BNP） ,left ventricular ejection fraction（ LVEF） ,ratio of mitral early diastolic velocity peak E value and late diastolic velocity peak A value（ E/A） ,ratio of mitral early diastolic wave peak e and late diastolic wave peak a（ e/a） and ratio of systolic S wave of peak pulmonary venous flow and early as well as mid diastolic D wave of peak pulmonary venous flow（S/D）,determined by cardiac color Doppler. Results With the development of T2DM,BNP increased significantly. Compared with other groups,TI and PI of overt heart failure group decreased significantly,with statistically significant differences（P〈0. 05）. Echocardiography showed that compared with healthy control group,E/A,e/a,S/D and LVEF of T2DM group decreased obviously,with statistically significant differences（P〈0. 05）. Conclusion With the development of T2DM,decrease of true insulin and proinsulin secretion level and decrease of myocardial diastolic compliance and contractility fall into a positive correlation,and secretion of BNP,a kind of heart failure related hormone increases significantly,which indicates that insulin-mediated low oxygen and glucose consumption as well as low energy supply make metabolic disorders related to energy supply occur to heart,affecting and worsening heart failure.