健康体检中糖耐量异常和2型糖尿病患者糖尿病性心肌病变及其影响因素分析  

Diabetic cardiomyopathy in medical examination patients with impaired glucose tolerance and Type 2 diabetes

作　　者：王雅琴[1] 杨娉婷[1] 曹霞[1] 刘梅林[2] 陈志恒[1] 

机构地区：[1]中南大学湘雅三医院健康管理中心,长沙410013 [2]北京大学第一医院心内科,北京100034

出　　处：《中南大学学报（医学版）》2014年第6期564-569,共6页Journal of Central South University ：Medical Science

基　　金："十二五"科技支撑计划项目(2012BAI37B05);湖南省科技厅社会发展科技支撑重点项目(2011SK2012);湖南省工程技术研究中心建设项目(2009TP4026)~~

摘　　要：目的:观察糖耐量异常(IGT)和2型糖尿病(T2DM)患者超声心动图改变及其影响因素,探讨糖尿病性心肌病的特征性改变和相关危险因素。方法:IGT及T2DM患者共682例,其中IGT组314例、T2DM组368例,另选年龄性别匹配的正常健康者为对照组(NC组,400例)。分析各组超声心动图的左室射血分数(LVEF)和室间隔厚度(IVSd)、一般资料、同期血糖、血脂及其他代谢指标。结果:与NC组比较,IGT组和T2DM组腰围(WC)、体质量指数(BMI)、早发心血管病家族史、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、高脂血症、尿素氮(BUN)和血肌酐(Cr)均显著增高(P<0.01);与NC组和IGT组比较,T2DM组LVEF显著降低,IVSd明显增厚(P<0.01);而NC组和IGT组之间,LVEF和IVSd比较差异无统计学意义(P>0.05)。相关性分析显示T2DM患者的LVEF与HbA1c,TC及病程呈负相关(P<0.01);IVSd与WC,BMI,HbA1c及病程呈正相关,与HDL呈负相关(P<0.05)。多元逐步回归分析显示HbA1c、病程均同时纳入LVEF和IVSd回归方程。结论:T2DM患者存在一定程度的心肌病变,且与血糖控制欠佳和病程长有关,而IGT患者心肌病变不明显。Objective: To investigate the change of diabetic cardiomyopathy in patients with impaired glucose tolerance(IGT) and Type 2 diabetes(T2DM) and its influencing factors. Methods: Patients with IGT and T2 DM were divided into an IGT group(n=314), a T2 DM group (n=368) and an NC group(400 normal subjects). The left ventricular ejection fractions(LVEF) and the interventricular septal depth(IVSd) were measured by Doppler echocardiography. The general information and blood biochemistry were also collected during the corresponding time period. Results: Compared with the NC group, waist circumference(WC), bodymass index(BMI), premature family history of cardiovascular disease, the serum levels of fasting plasma glucose(FPG), HbA1 c, TC, TG, hyperlipidemia, BUN and Cr significantly increased(P<0.01) in the IGT and T2 DM groups. Compared with the NC group and the IGT group, the LVEF significantly decreased(P<0.01) and the IVSd significantly increased(P<0.01) in the T2 DM group. The LVEF and IVSd did not have obvious difference between the NC group and the IGT group. Pearson correlation analysis showed a negative correlation between LVEF and HbA1 c, TC and duration of disease(P<0.01); but a positive correlation between IVSd and WC, BMI, HbA1 c and duration of disease, and a negative correlation between IVSd and HDL(P<0.05). In the multiple linear stepwise regression, HbA1 c and duration of disease showed a significant association with both LVEF and IVSd(P<0.05).Conclusion: T2 DM has a close association with cardiomyopathy. HbA1 c and duration of disease are the independent predictors for LVEF and IVSd.

关 键 词：糖耐量异常 2型糖尿病 糖尿病性心肌病 危险因素 

分 类 号：R587.1[医药卫生—内分泌]