降糖速率对2型糖尿病合并冠心病患者左心功能影响  

Influence of glucose-lowering rate on left ventricular function in type 2 diabetes mellitus patients with coronary heart disease

作　　者：孙振杰[1] 吴伟华[1] 王明丽[1] 邓巍[1] 杨磊[1] 孙丽芳[1] 苗佳晶[1] 郑召辉[1] 薛瑞凤[2] 黄金玮[2] 

机构地区：[1]哈尔滨医科大学附属第一临床医学院内分泌科二病房,150001 [2]唐山工人医院分院

出　　处：《中华内分泌代谢杂志》2010年第12期1050-1053,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：黑龙江省教育厅基金（11541133）

摘　　要：目的 研究降糖速率对2型糖尿病患者左心功能变化的影响.方法 对132例2型糖尿病患者和135例2型糖尿病合并冠心病患者强化降糖治疗,分析不同降糖速率下左心室射血分数（LVEF）、左心室舒张早、晚期充盈速度比（E/A）变化.结果 2型糖尿病组降糖速率≤6 mmol·L-1·-1及2型糖尿病合并冠心病组降糖速率≤4 mmol·L-1·d-1时LVEF较降糖前显著升高（P＜0.05）;2型糖尿病合并冠心病组降糖速率＞4 mmol·L-1·d-1时LVEF较降糖前显著降低（P＜0.05）,但随访时LVEF升高,亚组间比较差异无统计学意义（P＞0.05）.各亚组内比较降糖后E/A均升高（P＜0.05）.结论 2型糖尿病合并冠心病患者降糖速率过快会导致左心功能受损;血糖长期良好控制会修复降糖速率过快对左心功能的损伤.不论有无冠心病,降糖速率如何,强化降糖后最终左心舒张功能均改善.Objective To explore the influence of glucose-lowering rate on left ventricular function in patients with type 2 diabetes mellitus （T2DM）. Methods One hundred and thirty-two cases of type 2 diabetes mellitus and 135 cases of type 2 diabetes mellitus with coronary heart disease （T2DM＋CHD）received intensive glucose lowering therapy. Then, after measuring left ventricular ejection fraction （LVEF） and E/A ratio, the variation was analyzed. Results LVEF was significantly higher than that before intensive therapy in T2DMsubgroup with glucose-lowering rate less than 6 m mol · L-1 · d-1（ P〈0.05 ）. So was T2DM＋CHD subgroup with glucose-lowering rate less than 4 mmol· L-1 · d-1 （P〈0.05）. LVEF was significantly lower than that before intensive therapy in T2DM＋CHD subgroup with glucose-lowering rate greater than 4 mmol · L-1 · d-1（ P〈0. 05 ）,while by the end of following up for 3 months, LVEF stepped up and no significant difference was observed between subgroups （ P 〉 0. 05 ）. The E/A ratio stepped up in both subgroups after intensive therapy （ P 〈 0. 05 ）.Conclusions For T2DM patients with coronary heart disease, excessively fast glucose-lowering rate may impair left ventricular function. Long-term good control of blood glucose restores the impaired left ventricular function causes by excessively fast glucose-lowering rate. After intensive therapy, left ventricular diastolic function finally improves in both subgroups regardless of the glucose-lowering rate and coronary heart disease.

关 键 词：糖尿病 2型 冠状动脉疾病 左心功能 降糖速率 

分 类 号：R686[医药卫生—骨科学]