2型糖尿病患者左心房应变与微血管并发症的相关性研究

Correlation between left atrial strain and diabetic microvascular complications in patients with type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)患者左心房应变与微血管并发症的关系。方法收集2023年2至12月在空军军医大学第一附属医院内分泌科住院的165例T2DM患者作为研究对象。收集患者的年龄、性别、糖尿病病程、速效胰岛素使用情况、长效胰岛素使用情况, 检测糖化血红蛋白(HbA1c)、总胆固醇(TC)、尿白蛋白/肌酐比值(UACR)等指标, 采用二维斑点追踪超声测量左心室整体纵向应变(LVGLS)、左心房储存期应变(LASr)、左心房管道期应变(LAScd)、左心房收缩期应变(LASct)。根据糖尿病微血管并发症数目将患者分为单纯T2DM组(A组, 54例)、T2DM伴1种并发症组(B组, 69例)以及T2DM合并2~3种并发症组(C组, 42例)。采用单因素方差分析比较3组患者的基本情况、用药特征和生化指标。通过Spearman相关性分析、logistic回归分析评估左心房应变参数与糖尿病微血管并发症的相关性。结果 C组T2DM患者的LASr、LaScd、LVGLS均低于A组和B组, B组LASr、LAScd、LASct、LVGLS均低于A组(P<0.05)。Spearman相关分析结果显示, 糖尿病微血管并发症数目与左心房应变参数LASr(r=-0.381, P<0.001)、LAScd(r=-0.385, P<0.001)呈负相关, 与LASct(r=-0.151, P>0.05)无明显相关性。logistic回归分析结果显示, 在调整年龄、性别、糖尿病病程、使用速效胰岛素、使用长效胰岛素、HbA1c、TC、UACR、LVGLS后, 与A组相比, B组的LASr(OR=0.932, 95%CI 0.871~0.998)、LAScd(OR=0.910, 95%CI 0.840~0.987)和C组的LASr(OR=0.886, 95%CI 0.799~0.983)、LAScd(OR=0.823, 95%CI 0.719~0.942)均是合并并发症的影响因素(P<0.05)。结论 T2DM患者微血管并发症数目与左心房应变参数LASr、LAScd呈负相关。

Objective To investigate the relationship between left atrial strain and microvascular complications in patients with type 2 diabetes mellitus(T2DM).Methods A total of 165 T2DM patients who admitted to in the Department of Endocrinology,the First Affiliated Hospital of Air Force Military Medical University from February to December 2023 were collected.The age,sex,duration of diabetes mellitus,use of rapid-acting insulin,use of long-acting insulin were collected,glycated hemoglobin A 1c(HbA 1c),total cholesterol(TC),urinary albumin to creatinine ratio(UACR)were detected,left ventricular global longitudinal strain(LVGLS),left atrial storage strain during reservoir phase(LASr),left atrial strain during conduit phase(LAScd),left atrial strain during contraction phase(LASct)were examined by two-dimensional spot tracking echocardiography.According to the number of microvascular complications of T2DM,the patients were divided into simple T2DM group(group A,54 patients),T2DM with one complication group(group B,69 patients),and T2DM with 2-3 complications group(group C,42 patients).One-way analysis of variance was used to compare the baseline information,medication characteristics and biochemical indicators among the three groups.The relationship between left atrial strain parameters and microvascular complications of T2DM was evaluated by Spearman correlation analysis and logistic regression analysis.Results The LASr,LAScd,and LVGLS of patients in group C were lower than those in group A and group B,and the LASr,LAScd,LASct,and LVGLS of patients in group B were lower than those in group A(P<0.05).Spearman correlation analysis showed that the microvascular complications of diabetes mellitus were negatively correlated with left atrial strain parameters LASr(r=-0.381,P<0.001)and LAScd(r=-0.385,P<0.001),but not with LASct(r=-0.151,P>0.05).Logistic regression analysis showed that,after adjusting for age,sex,duration of diabetes mellitus,use of rapid-acting insulin,use of long-acting insulin,HbA 1c,TC,UACR,and LVGLS,compared with group A,LASr(OR=0.932,95%CI 0.871-0.998),LAScd(OR=0.910,95%CI 0.840-0.987)in group B and LASr(OR=0.886,95%CI 0.799-0.983)and LAScd(OR=0.823,95%CI 0.719-0.942)in group C were influencing factors associated with complications(P<0.05).Conclusion The number of microvascular complications in T2DM patients was negatively correlated with left atrial strain parameters LASr and LAScd.