老年2型糖尿病合并高血压患者糖化血红蛋白水平与左心室功能的相关性研究  

Relationship between Glycated Hemoglobin and Left Ventricular Function in Elderly Patients with Type 2 Diabetes Mellitus and Hypertension

作　　者：宋静[1] 朱敏[2] 

机构地区：[1]杭州师范大学附属医院(杭州市第二人民医院),浙江省杭州市310015 [2]复旦大学附属华山医院

出　　处：《中国全科医学》2013年第36期4253-4257,共5页Chinese General Practice

摘　　要：目的探讨老年2型糖尿病合并高血压患者糖化血红蛋白(HbA1c)水平与左心室功能的相关性。方法选取2008年1月—2013年7月在我院住院的老年2型糖尿病合并高血压患者153例,根据HbA1c水平将患者分为临床Ⅰ组(HbA1c<7.0%,71例)和临床Ⅱ组(HbA1c≥7.0%,82例)。采用彩色多普勒超声心动图测量患者的心脏结构指标,包括舒张末期左心室内径(LVIDd)、收缩末期左心室内径(LVIDs)、舒张末期室间隔厚度(IVSD)和舒张末期左心室后壁厚度(LVPWD),记录左心室射血分数(LVEF);采用酶联免疫吸附试验(ELISA)法测定患者血清N端前脑钠肽(NT-proBNP)水平。比较临床Ⅰ组和临床Ⅱ组上述指标的差异,并分析不同美国纽约心脏病学会(NYHA)分级的患者HbA1c水平的差异。结果临床Ⅱ组患者血清NT-proBNP水平〔(747±223)ng/L〕高于临床Ⅰ组〔(116±60)ng/L〕(P<0.05)。彩色多普勒超声心动图显示,临床Ⅱ组患者的心脏结构指标——LVIDd、LVIDs、IVSD、LVPWD均较临床Ⅰ组增高(P<0.05),而心功能评价指标——LVEF〔(65.3±7.8)%〕则低于临床Ⅰ组〔(68.9±4.8)%〕(P<0.05)。Pearson相关分析结果显示,HbA1c与血清NT-proBNP水平呈正相关(r=0.244,P=0.024)。NYHAⅡ、Ⅲ、Ⅳ级患者HbA1c水平依次升高〔(7.3±1.1)%、(8.5±1.2)%、(12.0±2.5)%〕(P<0.01)。结论老年2型糖尿病合并高血压患者中,HbA1c较高者的心脏结构改变明显,且HbA1c与NT-proBNP呈正相关。Objective To study the relationship between glycated hemoglobin （HbA1c） and left ventricular cardiac function in elderly patients with type 2 diabetes mellitus （T2DM） and hypertension. Methods 153 patients with T2DM and hy- pertension admitted to our hospital from January 2008 to July 2013 were divided into group I （HbAI0 〈 7. 0%, 71 cases） and group Ⅱ （ HbA1c ≥7.0%, 82 cases） . Eehoeardiography heart structure parameters, including left ventrieular end diameter di- astolic （LVIDd）, left ventricular end - systolic diameter （LVIDs）, interventrieular septum thickness at end - diastole （IVSD）, left ventricular posterior walldepth （LVPWD）, left ventricular ejection fraction （LVEF） were observed. The serum level of NT - proBNP was detected by ELISA. The above parameters were compared between the two groups, and the levels of HbA1c in patients with different NYHA classification were analyzed. Results The NT - proBNP level of group 1/ was significantly higher than groupⅠ [ （747 ±223） ng/L vs. （116 ±60） ng/L; P〈O. 051 ]Color Doppler echoeardiogram showed that the LVIDd, LVIDs, IVSD and LVPWD were significantly increased in groupⅡ compared with group [ （P 〈 0.05） . But LVEF in group 1] was lower than group Ⅱ [ （65.3 ± 7. 8 ） % vs. （68.9 ＋ 4. 8 ） % ; P 〈 0. 05 ]. Pearson correlation analysis showed that HbAlo was positively correlated with NT -proBNP （r =0. 244, P =0. 024） . NYHA grade Ⅱ , grade In, and grade IV patients had increased HbAlo level in that same order [ （7.3 ± 1.1 ） %, （ 8.5 ± 1.2） %, （ 12. 0± 2. 5 ） % ; P 〈 0. O11 ]Conclusion More significant cardiac structural change is observed in higher HbA,o level patients with T2DM and hypertension. Positive correla- tion exists between HbAlo and serum NT- proBNP.

关 键 词：高血压 糖尿病 2型 血红蛋白A 糖基化 心室功能 左 利钠肽 脑 

分 类 号：R544.1[医药卫生—心血管疾病] R587.1[医药卫生—内科学]