臂踝脉搏波传导速度与2型糖尿病患者心脏结构和功能相关性的研究

Correlation between brachial and ankle pulse wave velocity and cardiac structure and function in type 2 diabetes mellitus patients

目的探讨臂踝脉搏波传导速度(ba PWV)与T2DM患者心脏结构和功能的相关性。方法选取2022年6月至2023年10月于甘肃省人民医院内分泌科治疗的T2DM患者443例,根据ba PWV分为单纯T2DM组(T2DM,ba PWV<1400 cm/s,n=221)和动脉粥样硬化组(AS,ba PWV≥1400 cm/s,n=222)。心脏超声诊断仪记录左室射血分数(LVEF)、舒张末期左室内径(LVd)、舒张末期室间隔厚度(IVSd)、舒张末期左室后壁厚度(LVPWd)、二尖瓣环舒张早期与晚期血流峰值速度比值(E/A)、二尖瓣口舒张早期血流峰值速度与二尖瓣环舒张早期峰值速度比值(E/E’)。结果AS组年龄、DM病程、SBP、DBP、Hb A1c、TG、踝臂指数(ABI)、LVEF、IVSd、LVPWd、E/A<1、E/E’>14高于T2DM组(P<0.05或P<0.01)。Spearman相关分析显示,E/A<1与年龄、DM病程、BMI、SBP、DBP、ABI呈正相关(P<0.05或P<0.01),与ba PWV呈负相关(P<0.01)。Pearson相关分析显示,LVPWd与年龄、DM病程、BMI、SBP、DBP、ba PWV、Scr呈正相关(P<0.05或P<0.01)。Logistic回归分析显示,ba PWV、ABI、SBP是左心室舒张功能不全的影响因素。受试者工作特征曲线分析显示,ba PWV、SBP、ABI对左心室舒张功能不全预测价值的曲线下面积为0.647、0.643、0.624,最佳切点为1398.5 cm/s、125.5 mmHg、1.107。结论ba PWV与T2DM患者心脏结构和功能密切相关,随着ba PWV增加,左心室舒张功能不全、肥厚风险升高。

Objective To explore the correlation between brachial and ankle pulse wave conduction velocity(baPWV)and cardiac structure and function in patients with type 2 diabetes mellitus(T2DM).Methods A total of 443 patients with T2DM who were treated in The Endocrinology Department of Gansu Provincial People’s Hospital were enrolled in this study from June 2022 to October 2023.All the patients were divided into simple T2DM group(T2DM,baPWV<1400 cm/s,n=221)and atherosclerosis group(AS,baPWV≥1400 cm/s,n=222)based on baPWV.The cardiac ultrasound diagnostic instrument was used to record left ventricular ejection fraction(LVEF),end diastolic left ventricular diameter(LVd),end diastolic interventricular septal thickness(IVSd),end diastolic left ventricular posterior wall thickness(LVPWd),ratio of early to late diastolic peak velocity of mitral valve annulus(E/A),and ratio of early diastolic peak velocity of mitral valve orifice to early diastolic peak velocity of mitral valve annulus(E/E’).Results Age,DM duration,SBP,DBP,HbA1c,TG,ABI,LVEF,IVSd,LVPWd,E/A<1,E/E’>14,were higher in AS group than in T2DM group(P<0.05 or P<0.01).Spearman correlation analysis shows that E/A<1 was positively correlated with age,DM duration,BMI,SBP,DBP,and ABI(P<0.05 or P<0.01),while negatively correlated with baPWV(P<0.01).Pearson correlation analysis shows that LVPWd was positively correlated with age,DM duration,BMI,SBP,DBP,baPWV,and Scr(P<0.05 or P<0.01).Logistic regression analysis shows that baPWV,ABI,and SBP were the influencing factors for left ventricular diastolic dysfunction.The analysis of the working characteristic curve of the subjects shows that the area under the curve of baPWV,SBP and ABI for predicting left ventricular diastolic dysfunction is 0.647,0.643,and 0.624,with the best cutoff points being 1398.5 cm/s,125.5 mmHg,and 1.107.Conclusions baPWV is closely related to cardiac structure and function in T2DM patients.As baPWV increases,the risk of left ventricular diastolic insufficiency and hypertrophy rises.