射血分数保留的心力衰竭合并2型糖尿病患者的临床特征分析

Clinical feature analysis of patients with heart failure and diabetes with preserved ejection fraction

目的探讨射血分数保留的心力衰竭(HFp EF)合并2型糖尿病患者的临床特征。方法入选2016年1~12月在中国人民解放军武汉总医院心血管内科住院的HFp EF患者69例,根据是否合并2型糖尿病分为HFp EF合并糖尿病组和HFp EF未合并糖尿病组,对比分析两组患者的一般情况、实验室检查、临床用药和1年内心血管结局。结果 69例HFp EF患者中,29例合并2型糖尿病,其中15例女性,14例男性,平均年龄(75.8±10.7)岁;40例未合并2型糖尿病,其中19例女性,21例男性,平均年龄(75.3±10.3)岁,两组患者性别、年龄比较差异均无统计学意义(均为P>0.05)。HFp EF合并和未合并糖尿病组患者的体质指数[(24.8±2.9)kg/m^2比(23.0±2.7)kg/m^2]、平均收缩压[(139.0±20.9)mm Hg比(128.6±16.6)mm Hg]、合并高血压(89.7%比62.5%)及陈旧性心肌梗死(44.8%比15.0%)比例、N末端B型利钠肽原[(7 011.3±4 169.3)pg/ml比(4 767.2±3 151.2)pg/ml]、左心室肥厚比例(34.5%比12.5%)、左心房大小[(38.7±4.9)mm比(36.9±7.1)mm]、袢利尿剂(89.7%比67.5%)、钙离子通道拮抗剂(51.7%比27.5%)和硝酸酯类药物(89.7%比62.5%)使用率、1年内因心力衰竭恶化住院次数(1.3±0.89比0.45±0.9)及死亡率(10.3%比0)比较,差异均有统计学意义(均为P<0.05)。结论 HFp EF合并2型糖尿病更易发生在体质指数较高的人群中,较未合并的患者N末端B型利钠肽原浓度更高,更易出现心脏结构和功能异常,袢利尿剂、钙离子通道拮抗剂和硝酸酯类药物使用更多,临床结局更差。

Objective To investigate the differences in clinical features between patients with preserved heart failure（HFp EF） with or without diabetes. Methods From January 2016 to December2016,69 inpatients with HFp EF in the Department of Cardiology,Wuhan General Hospital of the Chinese People＇s Liberation Army were divided into HFp EF with diabetic group and HFp EF with non-diabetic group,and were compared with the general conditions,laboratory tests,clinical medications and cardiovascular outcomes within 1 year of the two groups of patients. Results Among the 69 patients,29 patients had diabetes mellitus,of whom 15 were females and 14 were males with an average age of（75. 8 ± 10. 7） years; 40 patients did not have diabetes,of whom 19 were females and 21 were males with an average of（75. 3 ± 10. 3）years old,there was no significant difference in gender and age between the two groups（all P〈0. 05）. There were significant differences in body mass index（BMI）,mean systolic blood pressure,combined hypertension,proportion of old myocardial infarction,N-terminal pro-B-type natriuretic peptide（NT-pro BNP）,left ventricular hypertrophy,left atrial enlargement,the use of loop diuretic,calcium channel blockers（CCB） and nitrates,worsening hospitalization of heart failure and hospital mortality within 1 year（all P〈0. 05）.Conclusions HFp EF with diabetes mellitus are more likely to occur in people with higher BMI. Compared with patients without diabetes,patients who with diabetes have higher NT-pro BNP concentration,more prone to have cardiac structure and functional abnormalities,more likely to use loop diuretics,CCB,nitrates,and have poorer clinical cardiovascular outcome.