ICU治疗的老年射血分数保留型心力衰竭患者右心室功能障碍与糖尿病的相关性

Correlation between right ventricular dysfunction and diabetes in elderly patients with heart failure with preserved ejection fraction treated in ICU

目的通过比较射血分数保留型心力衰竭(HFpEF)中糖尿病与非糖尿病患者的临床资料、超声心动图、心导管及右心室(RV)舒张、RV收缩功能障碍的发生率,评价老年HFpEF患者中糖尿病与RV功能障碍的相关性。方法选取2018年1月至2019年12月在广西壮族自治区民族医院全科医学科ICU治疗的老年HFpEF患者,根据患者是合并糖尿病将患者分为糖尿病组(n=82)与非糖尿病组(n=136),比较两组患者的临床资料、超声心动图指标、心导管指标与RV舒张障碍、RV收缩障碍发生率,采用多因素Logistics回归分析,评价患者糖尿病、糖化血红蛋白(HbA1c)的独立相关因素。结果纳入的218例患者中有81例(37.2%)老年HFpEF患者存在RV收缩功能障碍,39例(17.9%)存在RV舒张功能障碍。糖尿病与RV舒张功能障碍(OR=3.756,95%CI1.398~10.173,P=0.010)、RV收缩功能障碍(OR=5.086,95%CI1.521~16.975,P=0.008)独立相关。HbA1c也与RV舒张功能障碍(OR=1.810,95%CI 1.066~3.108,P=0.033)、RV收缩功能障碍(OR=1.882,95%CI 1.126~3.189,P=0.027)独立相关。而糖尿病患者与非糖尿病患者高肺血管阻力(PVR)比较差异无统计学意义(t=0.873,P=0.387)。结论糖尿病与老年HFpEF患者的RV收缩和舒张功能异常密切相关,与RV后负荷无关。

Objective To evaluate the correlation between diabetes mellitus and right ventricular(RV)dysfunction by comparing the incidence of clinical data,echocardiography indexes,cardiac catheterization indexes and right ventricular(RV)diastolic dysfunction and RV systolic dysfunction in the elderly patients with heart failure with preserved ejection fraction(HFpEF).Methods Elderly patients with HFpEF who were treated in the ICU of our hospital’s general medicine department from January 2018 to December 2019 were selected.According to the patients with or without diabetes,the patients were divided into diabetic group(n=82)and non-diabetic group(n=136).The clinical data,echocardiography indexes,cardiac catheterization indexes,RV diastolic dysfunction and RV systolic dysfunction were compared between the two groups.Multivariate Logistic regression analysis was used to evaluate the independent related factors of diabetes mellitus and glycosylated hemoglobin(HbA1 c).Results Among the 218 patients,81(37.2%)elderly patients with HFpEF had RV systolic dysfunction,39(17.9%)HFpEF patients had RV diastolic dysfunction.Diabetes mellitus was independently associated with RV diastolic dysfunction(OR=3.756,95%CI 1.398-10.173,P=0.010)and RV systolic dysfunction(OR=5.086,95%CI 1.521-16.975,P=0.008).HbA1 c was also independently associated with RV diastolic dysfunction(OR=1.810,95%CI 1.066-3.108,P=0.033)and RV systolic dysfunction(OR=1.882,95%CI 1.126-3.189,P=0.027).However,there was no significant difference in pulmonary vascular resistance(PVR)between diabetic patients and non-diabetic patients(t=0.873,P=0.387).Conclusion Diabetes mellitus is closely related to RV systolic dysfunction and diastolic dysfunction in elderly patients with HFpEF,but not related to RV afterload.