2型糖尿病患者糖化血红蛋白与心肌背向散射积分及心功能的关系  

Relation of hemoglobin A1c to myocardial integrated backscatter and cardiac function in patients with type 2 diabetes mellitus

作　　者：郭春艳[1] 谢苗荣[1] 滕一星[1] 沈潞华[1] 

机构地区：[1]首都医科大学附属北京友谊医院心血管中心,100050

出　　处：《北京医学》2015年第11期1068-1071,共4页Beijing Medical Journal

基　　金：首都临床特色应用研究课题基金(Z1311000040)

摘　　要：目的评价糖尿病早期糖化血红蛋白(Hb A1c)与心肌背向散射积分及心功能之间的关系。方法入选60例无心脏相关疾病的2型糖尿病患者为糖尿病组,同时选取56例年龄、性别相匹配的健康志愿者为对照组。对两组患者行超声心动图常规指标及心肌背向散射积分检查。糖尿病组患者测定Hb A1c水平。结果两组心肌收缩功能指标的差异无统计学意义(P>0.05)。糖尿病组二尖瓣舒张晚期峰值流速(A)高于对照组(P<0.01),E/A低于对照组(P<0.01),等容舒张期时间(IVRT)较对照组延长(P<0.05)。糖尿病组室间隔背向散射积分标化值(IVS-IBS%)和左室后壁背向散射积分标化值(LVPW-IBS%)高于对照组(P<0.01)。糖尿病组室间隔和左室后壁的背向散射积分周期变化幅度(CVIB)低于对照组(P<0.05)。Hb A1c与E/A(r=-0.31,P<0.05)呈负相关。Hb A1c与IVS-IBS%(r=0.58,P<0.01),LVPW-IBS%(r=0.55,P<0.01)呈正相关。IVS-IBS%与E/A(r=-0.35,P<0.05)呈负相关,LVPW-IBS%与E/A(r=-0.35,P<0.05)呈负相关。结论 2型糖尿病患者在心肌收缩功能受损之前即存在心肌声学及舒张功能的异常改变。背向散射积分是检测2型糖尿病患者早期心肌损伤的有效工具,2型糖尿病患者Hb A1c与左室心肌背向散射积分具有相关性。Objective To detect the relation between hemoglobin A1c（Hb A1c） and myocardial integrated backscatter as well as cardiac function in the early stage of DM. Methods Sixty DM2 patients（48.0±7.7 years） without evident heart disease and 56 age- and sex-matched normal controls（47.8±7.1 years） were enrolled. Indexes of conventional echocardiography, integrated backscatter of both groups were measured. Hb A1 c of DM2 patients were determined. Results There were no significant differences in systolic indexes between the two groups（P〈0.05）. Peak late diastolic mitral velocity（A） was higher（P〈0.01）, E/A was lower（P〈0.01） and isovolumetric relaxation time（IVRT） was longer（P〈0.05） in the DM group than the control group. IVS-IBS% and LVPW-IBS% were higher in the DM group than the control group（P〈0.01）. IVS- CVIB and LVPW- CVIB were lower in the DM group than the control group（P〈0.05）.Hb A1 c was negatively correlated with E/A（r =-0.31, P〈0.05）. Significant positive correlation was presented between Hb A1 c and IVS-IBS%（r = 0.58, P〈0.01）, LVPW-IBS%（r = 0.55, P〈0.01）. IVS-IBS% was negatively correlated with E/A（r =- 0.35,P〈0.05）, while LVPW- IBS% was negatively correlated with E/A（r =- 0.35,P〈0.05）. Conclusion Abnormal myocardial acoustic densitometry and diastolic dysfunction exist before the systolic function damages in DM2 patients. Integrated backscatter can be used as sensitive means for early assessing myocardial histological changes in DM2 patients. Hb A1 c is related with myocardial integrated backscatter.

关 键 词：2型糖尿病 糖化血红蛋白 背向散射积分 

分 类 号：R587.1[医药卫生—内分泌]