脉压对老年2型糖尿病患者心脏结构和功能的影响

Impact of pulse pressure on left ventricular geometry and function in elderly type 2 diabetic patients

目的采用三维斑点追踪技术评价脉压正常与脉压升高的老年2型糖尿病患者左心室结构及功能变化。方法收集76例老年非高血压的2型糖尿病患者,分为糖尿病合并高脉压组(n=36;24h脉压≥60mmHg)和糖尿病合并正常脉压组(n=40);另选40名年龄和性别相匹配且24h脉压正常的健康志愿者作为对照组。所有受检者均接受三维斑点追踪超声检查。结果 3组间左心室几何构型差异有统计学意义(χ~2=8.428,P=0.015),向心性重构和向心性肥厚在糖尿病合并高脉压组最多见。糖尿病合并正常脉压组仅整体纵向应变较对照组降低(P<0.001),但糖尿病合并高脉压组所有方向的应变值均较对照组和正常脉压组降低(P均<0.05)。结论三维斑点追踪技术可检测脉压正常和脉压升高的老年2型糖尿病患者心脏的亚临床异常。

Objective To evaluate left ventricular geometry and function in elderly type 2 diabetic patients with normal and high pulse pressure by using three-dimensional speckle-tracking echocardiography （3DSTE）. Methods A total of 76 elderly non-hypertensive type 2 diabetic patients were divided into type 2 diabetic combined with high pulse pressure group （n=36; 24 h pulse pressure ≥60 mmHg） and type 2 diabetic combined with normal pulse pressure group （n=40）. Forty age- and sex-matched healthy volunteers with normal 24 h pulse pressure were recruited as control group. 3DSTE was performed in all participants. Results Significant differences in left ventricle geometry were found among the three groups （x^2 = 8. 428, P=0. 015）, and concentric geometry was most prevalent in type 2 diabetic patients with high pulse pressure group. Global longitudinal strain in type 2 diabetic patients with normal pulse pressure group was significantly lower than that of control group （P〈0. 001）. The type 2 diabetic combined with high pulse pressure group showed severely lower strain values in all directions compared with control group and type 2 diabetic combined with normal pulse pressure group （all P〈0.05）. Conclusion 3DSTEC can detect subclinical cardiac abnormalities in elderly type 2 diabetic patients with normal and high pulse pressure.