无心血管疾病病史血压正常T2DM老年患者LVDD影响因素

Analysis of influencing factors of left ventricular diastolic dysfunction in elderly patients with type 2 diabetes mellitus without cardiovascular disease

目的探讨无心血管疾病病史血压正常的2型糖尿病(T2DM)老年患者左心室舒张功能不全(LVDD)影响因素。方法回顾性选择2018年9月至2021年9月亳州市人民医院内分泌科收治的因T2DM入院治疗无心血管疾病病史且无高血压病史老年患者为研究对象,参照2016美国超声心动图学会和欧洲心血管成像协会制定的LVDD诊断标准,将160例患者分为LVDD组和非LVDD组。通过电子病历获取患者性别、年龄、糖尿病病程、体重指数、吸烟史、饮酒史等一般资料以及各项实验室检查指标检测结果,比较LVDD组和非LVDD组超声心动图检查结果,以单因素分析和多因素Logistics回归分析T2DM老年患者左心室舒张功能不全影响因素。结果160例老年T2DM患者中64例被诊断为LVDD,其中LVDD I级39例,LVDDⅡ级18例,LVDDⅢ级7例。LVDD组E、E/e’高于非LVDD组,e’、E/A低于非LVDD组,差异均有统计学意义(P<0.05)。单因素分析结果显示,无心脏疾病史老年T2DM患者并发LVDD与性别、年龄、糖尿病病程、吸烟史、饮酒史、甘油三酯、总胆固醇、LDL-C、HDL-C无关(P<0.05);LVDD组与非LVDD组体重指数、血糖控制达标、血肌酐和合并微量蛋白尿比较,差异有统计学意义(P<0.05);多因素Logistics回归分析结果显示,体重指数、血糖控制达标、血肌酐和合并微量蛋白尿均为无心脏疾病史老年T2DM患者并发LVDD的独立影响因素(P<0.05)。ROC分析结果显示,体重指数和血肌酐预测老年T2DM患者发生LVDD曲线下面积分别为0.863和0.814,95%CI分别为0.787~0.938和0.721~0.907,敏感度分别为82.86%、76.89%,特异度分别为81.85%和75.66%。结论体重指数、血糖控制达标、血肌酐和合并微量蛋白尿是无心血管疾病且无高血压病史T2DM老年患者发生LVDD的影响因素,应加强对以上临床因素的关注以降低LVDD发生率。

Objective To investigate the influencing factors of left ventricular diastolic dysfunction(LVDD)in elderly patients with type 2 diabetes mellitus(T2DM)without cardiovascular disease.Methods Elderly patients with no cardiovascular disease and no history of hypertension who were admitted to hospital for T2DM from September 2018 to September 2021 in the Department of Endocrinology Bozhou People's Hospital were retrospectively selected as the research subjects,according to the diagnostic criteria of LVDD formulated by the American Society of Echocardiography and the European Society of Cardiovascular Imaging in 2016,160 patients were divided into LVDD group and non-LVDD group.General information such as gender,age,duration of diabetes,body mass index,smoking history,drinking history,and the test results of various laboratory indicators were obtained through electronic medical records,and the echocardiographic results of the LVDD group and the non-LVDD group were compared.Analysis and multivariate logistic regression analysis were performed to analyze the influencing factors of left ventricular diastolic dysfunction in elderly patients with T2DM.Results Among the 160 elderly T2DM patients,64 were diagnosed with LVDD,including 39 cases of LVDD grade I,18 cases of LVDD gradeⅡ,and 7 cases of LVDD gradeⅢ;LVDD group E,E/e'were higher than non-LVDD group,e',E/A was lower than the non-LVDD group,and the differences were statistically significant(P<0.05).Univariate analysis showed that LVDD in elderly T2DM patients without a history of heart disease was associated with gender,age,duration of diabetes,smoking history,drinking history,triglyceride,total cholesterol,LDL-C,and HDL-C had no relationship(P<0.05);there were statistically significant differences in body mass index,blood glucose control,sCr,and combined microalbuminuria between the LVDD group and the non-LVDD group(P<0.05);multiple factors The logistic regression analysis showed that body mass index,blood glucose control,sCr and microalbuminuria were independent influencing factors of LVDD in elderly T2DM patients without history of heart disease(P<0.05).ROC analysis showed that the area under the curve of body mass index and sCr in predicting LVDD in elderly patients with T2 DM was 0.863 and 0.814,respectively.The 95%CI was 0.787-0.938 and 0.721-0.907,respectively.The sensitivity was 82.86%and 76.89%,and the specificity was 81.85%and 75.66%,respectively.Conclusion Body mass index,glycemic control,sCr and concomitant microalbuminuria are the influencing factors of LVDD in elderly T2DM patients without cardiovascular disease and history of hypertension.More attention should be paid to the above clinical factors to reduce the incidence of LVDD.