2型糖尿病患者冠脉微血管功能与左室充盈压的相关性研究

Association between the coronary microvascular function and left ventricle perfusion pressure in type 2 diabetes patients

目的探讨2型糖尿病患者冠脉微血管功能与左室舒张功能不全引起的左室充盈压增高的相关性。方法纳入2015年7月至2015年12月在岳阳市一人民医院心内科和老年科连续就诊的67例2型糖尿病患者(糖尿病组),以同期28例健康体检者作为对照组。采用经胸多普勒超声心动图(包括左前降支二尖瓣环和冠脉血流回流脉冲组织多普勒)进行检查,计算二尖瓣速率与二尖瓣环早期舒张速率的比值E/e′,评价其与左室舒张功能的相关性。结果糖尿病组左心房直径、E/e′比值及冠脉血流回流与对照组比较差异有显著性[(36.2±4.4)vs(33.5±4.3),(9.3±2.7)vs(7.6±1.1),(3.3±0.8)vs(3.8±0.7),P<0.05]。糖尿病组舒张功能异常分布较对照组显著增加。多因素分析结果显示左室重量指数(P=0.023)及冠脉血流回流(P=0.043)为E/e′异常的独立预测因子。结论 2型糖尿病患者冠脉微血管功能中的冠脉血流回流与左室舒张功能不全引起的左室充盈压增高相关。

Objective To explore whether coronary flow reserve （CFR）, which reflects coronary microvascular function, is associated with LV diastolic dysfunction in patients with type 2 diabetes. Method A total of 67 consecutive type 2 diabetes patients and 28 cases of health examiners as control group were included between July, 2015 and December, 2015 from the Department of Cardiology and Geriatric of the First People＇s Hospital of Yueyang. Transthoracic Doppler echocardiography was performed that included pulsed tissue Doppler of the mitral annulus and CFR of the left anterior descending artery. The ratio of mitral velocity to early diastolic velocity of the mitral annulus （E/ e ＇） was used as a surrogate marker of diastolic function. Result According to the indicators by echocardiogarahy, LV diameter, E/e＇ and CFR showed significantly difference between diabetes patients and controls [（36.2± 4.4） vs （33.5± 4.3）,（ 9.3± 2.7） vs（7.6 ± 1.1）; （3.3± 0.8） vs （3.8±0.7）, all P〈0.05]. Multivariate analysis indicated that both LV mass index （P=0.023） and CFR （P=-0.043） were independently associated with E/e＇. Conclusion CFR was associated with LV filling pressure in patients with type 2 diabetes. This result suggests a possible link between coronary microvascular disease and LV diastolic fimction in these subjects.