2型糖尿病患者颈动脉粥样硬化与亚临床左心室功能受损的相关性研究

Correlation between carotid atherosclerosis and subclinical left ventricular dysfunction in patients with type 2 diabetes

目的探讨左室射血分数(left ventricular ejection fraction,LVEF)保留的2型糖尿病患者颈动脉粥样硬化(carotid atherosclerosis,CAS)病变与亚临床左心室功能受损的关系。方法选取2021年6月至2021年10月就诊于空军军医大学第一附属医院内分泌科住院治疗的120例LVEF≥50%的2型糖尿病患者。二维斑点追踪超声心动图(speckle tracking echocardiography,STE)测量左心室整体纵向应变(global longitudinal strain,GLS),评估亚临床左室收缩功能;脉冲组织多普勒超声测量计算舒张早期二尖瓣血流速度(E峰)/舒张晚期二尖瓣血流速度(A峰)、E峰/舒张早期二尖瓣环血流速度(E′峰)比值,评估左室舒张功能。根据颈动脉超声检查,将研究对象分为颈动脉超声正常组(n=46)和CAS组(n=74)。比较2组一般人口学特征及血生化指标。利用二元logistic回归模型、Pearson相关分析评估CAS病变与亚临床左心室功能受损的关系。结果与颈动脉超声正常组相比,CAS组男性所占比例更高、年龄更大、糖尿病病程更长(均P<0.05)。LVEF、GLS在2组间差异无统计学意义[颈动脉超声正常组比CAS组分别为(60.72±4.73)%对(60.07±4.28)%,(18.24±3.72)%对(17.81±3.47)%,均P>0.05]。与颈动脉超声正常组相比,CAS组患者E/A比值显著降低,E/E′比值显著增加,差异有统计学意义(均P<0.01)。Pearson相关分析结果显示,GLS与颈动脉斑块厚度、颈动脉内膜中层厚度(carotid intima-media thickness,CIMT)不相关(P>0.05),相比,E/E′比值与颈动脉斑块厚度、CIMT呈正相关(均P<0.05)。二元logistic回归结果显示,GLS、E/E′比值与CAS病变发生不相关(均P>0.05),E/A比值降低与CAS病变发生显著相关(OR=0.09,95%CI 0.01~0.67,P=0.018)。结论在无明显心衰症状且LVEF≥50%的2型糖尿病患者中,CAS的发生与GLS评估的亚临床左室收缩功能受损无关;与左室舒张功能减退显著相关,且独立于传统心血管危险因素。

Objective To investigate the relationship between carotid atherosclerosis(CAS)and subclinical left ventricular(LV)dysfunction in type 2 diabetes mellitus patients with preserved LV ejection fraction(LVEF).Methods A total of 120 patients with type 2 diabetes mellitus who had LVEF≥50%were selected in the Department of Endocrinology,the First Affiliated Hospital of Air Force Medical University from June 2021 to October 2021.The global longitudinal strain(GLS)was obtained by two-dimensional speckle tracking echocardiography(STE)to assess subclinical LV systolic function.The mitral ratio of peak early to late diastolic filling velocity(E/A),and mitral velocity to early diastolic velocity of the mitral annulus(E/E′)ratio were obtained by pulsed tissue Doppler echocardiography to assess LV diastolic function.Acrroding to bilateral carotid ultrasound examination,the subjects were divided into normal carotid arteries group(n=46)and CAS group(n=74).Demographics and biochemical parameters were compared between two groups.Binary logistic regression and Pearson correlation analysis were used to evaluate the relationship between CAS and subclinical LV dysfunction.Results The CAS group had a higher proportion of men,older age,and a longer duration of diabetes than the normal carotid arteries group(all P<0.05).There was no difference in LVEF and GLS between the two groups[normal carotid arteries group vs CAS group,LVEF:(60.72±4.73)%vs(60.07±4.28)%;GLS:(18.24±3.72)%vs(17.81±3.47)%,respectively;both P>0.05].However,compared with normal carotid arteries group,E/A ratio was decreased and E/E′ratio was significantly increased in CAS group(both P<0.01).Pearson correlation analysis showed that GLS was not correlated with carotid plaque thickness and carotid intima-media thickness(CIMT;both P>0.05).By contrast,E/E′ratio was positively correlated with carotid plaque thickness and CIMT(both P<0.05).Binary logistic regression analysis showed that GLS and E/E′ratio were not associated with CAS(both P>0.05).However,decreased E/A ratio was significantly associated with the existence of CAS(OR=0.09,95%CI 0.01-0.67,P=0.018).Conclusions In type 2 diabetes mellitus patients without overt heart failure and with preserved LVEF,the occurrence of CAS is not associated with subclinical LV systolic impairment assessed by GLS,but is significantly associated with LV diastolic dysfunction,and is independent of traditional cardiovascular risk factors.