肥胖对中青年糖尿病患者心功能的影响

Influence of Obesity on Cardiac Function in Young and Middle-aged Diabetic Patients

目的探讨肥胖对中青年糖尿病患者心功能的影响。方法选取2019年1月至2020年1月在郑州大学附属郑州中心医院住院治疗的80例中青年糖尿病患者为研究对象,提前去除体质量指数(BMI)小于18.5或25~<30 kg·m^(-2)的患者。按照BMI分组,BMI为18.5~24.9 kg·m^(-2)的为非肥胖糖尿病组,共48例,BMI超过30 kg·m^(-2)的为肥胖糖尿病组,共32例。对肥胖糖尿病组患者筛查多导睡眠监测并记录睡眠呼吸暂停低通气指数(AHI),采用超声心动图仪对两组患者进行检查,记录患者主动脉内径(AOD)、左室收缩期内径(LVDs)、射血分数(EF)、室间隔厚度(IVS)、左室短轴缩短率(FS)、左房内径(LAD)、左心室质量(LVM)、左室舒张期内径(LVDd)、左室后壁厚度(LVPW)、二尖瓣E峰与A峰比值(E/A),记录两组患者甘油三酯(TG)、BMI、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、舒张压(DBP)、空腹血糖(FPG)、收缩压(SBP)、空腹胰岛素(FINS)水平。在肥胖糖尿病组患者中进行LVM、血脂、HbA1c、SBP、FINS、DBP及AHI指数等指标与EF的相关性分析,研究影响患者EF的主要因素。结果两组患者LVDs、AOD、EF、IVS、LVDd、FS比较,差异无统计学意义(P>0.05);肥胖糖尿病组LVPW、HOMA-IR、LAD、BMI、LVM、TG、FINS和DBP水平高于非肥胖糖尿病组,E/A、FPG、HbA1c水平低于非肥胖糖尿病组,差异有统计学意义(P<0.05)。肥胖糖尿病组患者EF与患者病程、SBP呈正相关(P<0.05),与患者LVM、FINS、TC呈负相关(P<0.05),与年龄、FPG、TG、BMI、HbA1c、DBP无相关性(P>0.05);进一步行多重线性回归分析结果显示,肥胖糖尿病组患者EF主要受AHI指数、SBP和LVM影响(F=76.293,P<0.05),其中AHI指数影响最大,其次为LVM,3个变量可以解释EF 67%的变异。结论AHI、左心室质量是影响肥胖糖尿病患者EF的主要因素,值得临床给予关注。

Objective To explore the influence of obesity on cardiac function in young and middle-aged diabetic patients.Methods The study included 80 young and middle-aged people with diabetics who were hospitalized in the Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2019 to January 2020.Patients with body mass index(BMI)less than 18.5 or 25-<30 kg·m^(-2) were removed early.Grouping by BMI,the BMI range of 18.5-24.9 kg·m^(-2) was non-obese diabetic group,a total of 48 cases,BMI over 30 kg·m^(-2) was the obese diabetic group,a total of 32 cases.Patients of the obese diabetic group were screened for polysomnography and sleep apnea hypopnea index(AHI)was recorded,and the two groups of patients were examined by echocardiography.The aortic meridian(AOD)and left ventricular systolic diameter(LVDs),ejection fractions(EF),ventricular septal thickness(IVS),fraction shortening(FS),left atrium diameter(LAD),left ventricular mass(LVM),left ventricular diastolic diameter(LVDd),left ventricular wall thickness(LVPW),peak E and A of the mitral valve Peak ratio(E/A),record triglyceride(TG),BMI,Glycated hemoglobin(HbA1c),Homeostasis model assessment of insulin resistance(HOMA-IR),diastolic blood pressure(DBP),fasting blood glucose(FPG),systolic blood pressure(SBP),fasting insulin(FINS)levels were recorded.The correlation analysis of LVM,lipid,HbA1c,SBP,FINS,DBP,AHI and other indicators with EF was conducted in the obese diabetic group,and the main factors affecting EF were studied.Results There were no differences in LVDs,AOD,EF,IVS,LVDd,FS between the two groups of patients(P>0.05).The levels of LVPW,HOMA-IR,LAD,BMI,LVM,TG,FINS and DBP in the obese diabetes group was higher than those in the non-obese diabetic group(P<0.05).The levels of E/A,FPG and HbA1c in the obese group was lower than those in the non-obese group(P<0.05).EF was positively correlated with the course of disease and SBP(P<0.05),but negatively correlated with LVM,FINS and TC(P<0.05).EF was not correlated with age,FPG,TG,BMI,HbA1c and DBP(P>0.05).The EF of obese patients were mainly affected by AHI index,SBP and LVM(F=76.293,P<0.05),of which AHI index had the greatest impact,the second was LVM.This variable can explain 67%of the variation of EF.Conclusion AHI and LVM are the main factors that affect the EF of obese diabetic patients,which deserves clinical attention.