左心室亚临床心肌收缩功能障碍对临床前糖尿病患者预后的影响

Effect of Subclinical Left Ventricular Systolic Dysfunction on Prognosis of Prediabetic Patients

目的多数研究证实糖尿病前期患者发生左心室心肌亚临床收缩功能障碍,但其预后意义尚不清楚。本文拟探讨左心室亚临床收缩功能障碍对临床前糖尿病患者的预后价值。资料与方法采用前瞻性队列研究的方法,选择2013年1月—2014年1月延安市人民医院体检中心及门诊具备完整随访资料的临床前糖尿病患者98例。收集2年随访期间常规生化、超声心动图以及左心室整体纵向应变等数据资料。随访过程中发生糖尿病的患者纳入糖尿病组,未发生糖尿病的患者纳入非糖尿病组。随访结束后,比较两组基线资料,筛选临床前糖尿病进展为临床期糖尿病的危险因素。结果随访期共38例患者发生了临床期糖尿病。Cox回归分析显示,腹型肥胖(HR:2.662,95%CI:1.374~5.159,P=0.004),腰臀比(HR:1.917,95%CI:1.012~3.492,P=0.001),舒张早期二尖瓣血流速度与二尖瓣环位移速度比值(HR:1.661,95%CI:1.336~2.065,P<0.001),糖化血红蛋白(HR:2.029,95%CI:1.047~3.932,P<0.001),左心室纵向应变(HR:0.786,95%CI:0.728~0.848,P<0.001)是临床前糖尿病进展为临床期糖尿病的独立危险因素。受试者工作特性(ROC)曲线分析显示,以左心室纵向应变<18%为截点值,预测糖尿病前期进展为糖尿病的曲线下面积为0.796(95%CI:0.704~0.888,P<0.001),预测敏感度为46.7%、特异度为89.5%。结论左心室亚临床心肌收缩功能障碍是临床前糖尿病进展为临床期糖尿病的早期预测因子。早期检测临床前糖尿病左心室收缩功能异常可为临床早期干预提供依据。

Purpose Many studies have shown that subclinical left ventricular systolic dysfunction is seen in prediabetic patients. However, its relationship with prognosis is unclear. The purpose of this study is to investigate the prognostic value of subclinical left ventricular systolic dysfunction with prediabetes. Materials and Methods This was a prospective clinical cohort study. A total of 98 prediabetes patients with complete medical record and follow up data in the physical exam center and the clinic of Yan’an People’s Hospital were chosen between January 2013 and January 2014. The biochemical data, echocardiography and left ventricular global longitudinal strain（GLS） in 2 years of follow up were collected. The subjects were grouped into diabetes if the diagnosis was confirmed during follow up, or non-diabetes group if not diagnosed. After follow up, the baseline parameters were compared to screen for risk factors to develop clinical diabetes. Results During the study, 38 participants were diagnosed as clinical diabetes. Cox proportional hazard regression models show that obesity [hazard ratio（HR）： 2.662, 95% CI 1.374-5.159, P=0.004], waist-hip ratio（HR： 1.917, 95% CI： 1.012-3.492, P=0.001）, mitral E/e’ ratio（HR： 1.661, 95% CI： 1.336-2.065, P〈0.001）, Hb A1c（HR： 2.029, 95% CI： 1.047-3.932, P〈0.001）, global longitudinal strain（HR： 0.786, 95% CI： 0.728-0.848, P〈0.001） were significant independent predictors for developing diabetes. Using GLS〈18% as cutoff value, the area under receiver operating characteristic（ROC） curve to predict development of diabetes was 0.796（95% CI： 0.704-0.888, P〈0.001）, with sensitivity and specificity of 46.7% and 89.5%, respectively. Conclusion Among modifiable risk factors in patients with prediabetes, subclinical left ventricular systolic dysfunction is an early indicator of progressing to diabetes. Early detection of left ventricular systolic dysfunction in prediabetes can provide the basis for early clinical intervention.