2型糖尿病患者并发左心室舒张功能减退的危险因素分析

The risk factors of type 2 diabetes mellitus combined with left wentricular diastolic dysfunction

目的:在我国2型糖尿病患者中,有很大一部分患者并发左心室舒张功能减退。但是导致左心室舒张功能减退的机制仍不明确。本研究的目的在于研究探讨导致2型糖尿病患者并发左心室舒张功能减退的危险因素。方法:本实验研究对象为101名无症状2型糖尿病患者,确诊为糖尿病时,未发现心脏疾病(包括左心室舒张功能减退)。患者排除标准为心功能纽约分级大于1级,射血分数小于50%,既往有冠心病病史,或肌酐清除率小于30mL/min,以及应用胰岛素治疗的患者。在入组的101名患者中,43名患者在患2型糖尿病病程中发现左心室舒张功能减退。左心舒张功能通过二尖瓣瓣口血流流速曲线中舒张早期左室充盈速度与组织多普勒成像二尖瓣环舒张早期血流速度的比值(E/e')来评估,分为正常组及左心室舒张功能减退组,即实验组。检测空腹血糖,空腹血浆胰岛素浓度,血脂水平,及其他临床指标,并探讨其与左心室舒张功能减退之间的关系。结果:本实验研究结果表明,两组之间比较患者性别(女性),糖尿病病程,收缩压,脉搏,空腹胰岛素浓度,以及磺脲类药物的使用均具有统计学意义(P<0.05),Logistic回归分析表明患者性别(女性),糖尿病病程,收缩压,空腹胰岛素浓度,以及磺脲类药物的使用是2型糖尿病患者并发左心室舒张功能减退的独立危险因素。结论:性别(女性),糖尿病病程,高血压,高胰岛素血症及磺脲类药物的应用可能是导致2型糖尿病患者左心舒张功能减退的危险因素。

Objective:Although diabetes mellitus is an indepent risk of heart failure with preserved ejection fraction,the underlying mechanisms leading to c remain poorly understood.The study was aimed to access the risk factors for LVDD in patients with type 2 diabetes mellitus.Methods:101 asymptomatic patients with type 2 diabetes mellitus without overt heart disease were enrolled in this study.Patients with New York Heart Association class>1,ejection fraction<50%,history of coronary artery disease,severe valvulopathy,chronic atrial fibrillation,or creatinine clearance<30 mL/min,as well as those receiving insulin treatment,were excluded.Among all 101 patients,43 patients were found combined with heart failure with preserved ejection fraction.Left ventricular diastolic function was estimated as the ratio of early diastolic velocity(E)from transmitral inflow to early diastolic velocity(e')of tissue Doppler at mitral annulus(E/e').Total patients were divided into two groups,normal and heart failure with preserved ejection fraction.Parameters of glycemic control,plasma insulin concentration,lipid profile,treatment with antidiabetic drugs,and other clinical characteristics were evaluated,and their association with heart failure with preserved ejection fraction determined.Results:Results showed that sex,duration of diabetes,systolic blood pressure,pulse pressure,fasting insulin concentration,and sulfonylurea use have significant differences between two groups.Logistic analysis showed that Sex(female),duration of diabetes,hypertension,hyperinsulinemia and sulfonylurea use maybe risk factors in the development of LVDD in patients with type 2 diabetes mellitus.Conclusion:Sex(female),duration of diabetes,hypertension,hyperinsulinemia and sulfonylurea use maybe risk factors in the development of LVDD in patients with type 2 diabetes mellitus.