控制血糖和血压对2型糖尿病和高血压病患者心脏的影响  

Influences of Controlling Blood Glucose and Blood Pressure on Cardiac Structure and Function in Patients with Type 2 Diabetes Mellitus and Essential Hypertension

作　　者：刘璟瑜[1] 徐文[1] 刘勇[1] 何辉[1] 罗永芬[1] 张莉[1] 曾朝荣[1] 任艳[2] 

机构地区：[1]成都市第七人民医院,四川成都610021 [2]四川大学华西医院,四川成都610041

出　　处：《现代临床医学》2007年第4期248-251,共4页Journal of Modern Clinical Medicine

摘　　要：目的:探讨2型糖尿病(T2DM)、原发性高血压(EH)、EH并T2DM(EH+T2DM)患者心肌收缩力受损害的差别及部分影响因素。并探讨在严格控制血糖和(或)血压及相关危险因素的情况下能否逆转或阻滞心脏构造和功能的损害。方法:采用超声心动图(UCG)评价32例正常人、67例EH、32例T2DM和35例EH+T2DM患者的左心室壁内缩短分数(MFS)及应力相关MFS(S-cMFS),并同时检测糖化血红蛋白A1(HbAlc)、血糖(GL)、24小时尿总蛋白(TuA)、尿微量白蛋白(MuA)、肾功能和血脂。并在严格控制血糖和(或)血压及相关危险因素半年后重复上述评价。结果:与正常组比较,EH、T2DM和EH+T2DM组MFS和S-cMFS明显减少,T2DM和EH+T2DM组更为明显;单变量相关分析显示HbAlc、MuA、总胆固醇(CH)、甘油三酯(TG)、低密度脂蛋白(LDL)与MFS和S-cMFS呈显著负相关,多变量相关分析提示仅HbAlc与MFS和S-cMFS显著相关。治疗后MFS、S-cMFS得到明显改善,尤以T2DM和EH+T2DM组更为明显。结论:EH、T2DM和EH+T2DM患者心肌收缩力明显损害,尤以EH+T2DM患者更显著,HbAlc和MuA是损害心肌收缩力的重要因素,CH、TG、LDL也可能具有不良影响。通过半年严格控制血糖和(或)血压能阻滞或逆转DM、EH、DM+EH患者左室构造和功能的损害,似乎T2DM和EH+T2DM患者的疗效更好。Objective： To discuss the different of myocardium contractility injury and affecting factors in patients with type 2 diabetes mellitus （T2DM） and essential hypertension（EH） or both type 2 diabetes mellitus and essential hypertension （T2DM ＋ EH） ; and to explore whether cause a reversion or retardance of injury in the cardiac structure and function after strictly controlling blood glucose or / and blood pressure. Methods：The left ventricular midwall fractional shortening （MFS） and stress - corrected MFS （S - cMFS ） were assessed by Doppler echocardiography,at the same time, HbAlc, blood glucose （GL）, total urinary albuminuria （TuA） and urinary mieroalbumin of 24 hours （MuA）, renal function （blood urea, ereatinine） and serum lipids [ total cholesterol （CH）, triglyceride （TG）, low density hpoprotein- cholesterol （LDL）] were measured in 32 cases of normal people, 32 cases of T2DM, 67 cases of EH and 35 cases of T2DM ＋ EH. Then, the aforesaid estimates were repeated after blood glucose, blood pressure and the dangerous factors relative to the disease had been strictly controlled a half year later. Results： MFS and S - cMFS in EH, T2DM and T2DM ＋ EH patient groups, especially in T2DM and T2DM ＋ EH patient groups decreased significantly compared with normal group. One - way analysis of variance showed that HbMc, CH, TG and LDL were negatively correlated with MFS and S - cMFS. Multivariate linear regression analysis indicated that only HbAlc was positively related to MFS and S- cMFS. After the patients were remedied, their MFS and S- cMFS had visibly improved. Conclusion： The myoeardium contractility is significantly damaged in EH, T2DM, and T2DM ＋ EH patients groups, especially the T2DM ＋ EH patients group. HbAlc and MuA are the two of important factors for myoeardium contractility injury. Maybe, CH,TG and LDL have the harmful affection. After strictly controlling blood glucose or / and blood pressure half a year, the left ventricular can be reversed or

关 键 词：高血压 2型糖尿病 室壁内缩短分数(MFS) 影响因素 

分 类 号：R587.1[医药卫生—内分泌] R544.1[医药卫生—内科学]