糖尿病性心肌病早期诊断指标分析  

Early Diagnostic Index for Diabetic Cardiomyopathy

作　　者：冯然[1] 梁丽青[1] 蔡欢[2] 刘静芹[1] 

机构地区：[1]河北省保定市第一医院内分泌科,071000 [2]河北师范大学体育学院

出　　处：《实用心脑肺血管病杂志》2016年第11期86-89,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的分析糖尿病性心肌病(DCM)的早期诊断指标。方法选取2013—2015年在保定市第一医院内分泌科就诊的2型糖尿病(T2DM)患者318例,根据心脏彩色多普勒超声检查结果分为左心室舒张功能减低70例(DCM组)和心功能正常248例(对照组)。比较两组患者性别、年龄、职业、文化程度、糖尿病病程、体质指数(BMI)、血糖指标〔空腹血糖(FBG)和糖化血红蛋白(HbA_(1c))〕、血脂指标〔总胆固醇(TC)、三酰甘油(TG)、极低密度脂蛋白(VLDL)、低密度脂蛋白(LDL)〕、胰岛素(INS)、C肽(C-P)、超敏C反应蛋白(hs-CRP)、D-二聚体(D-D)、B型脑钠肽(BNP)及尿微量清蛋白排泄率(UAER)。结果两组患者性别和职业比较,差异有统计学意义(P<0.05);两组患者年龄和文化程度比较,差异无统计学意义(P>0.05)。DCM组患者糖尿病病程长于对照组,FBG、HbA_(1c)、TG、VLDL、hs-CRP、D-D、BNP水平及UAER高于对照组(P<0.05);两组患者BMI及TC、LDL、INS、C-P水平比较,差异无统计学意义(P>0.05)。多因素logistic回归分析结果显示,糖尿病病程〔OR=1.118,95%CI(1.007,1.241)〕、HbA_(1c)〔OR=1.859,95%CI(1.188,2.910)〕、TG〔OR=1.792,95%CI(1.036,3.099)〕、hs-CRP〔OR=1.779,95%CI(1.102,2.871)〕、D-D〔OR=39.460,95%CI(2.546,611.607)〕、BNP〔OR=2.072,95%CI(1.082,3.967)〕是DCM的独立危险因素(P<0.05)。结论 HbA_(1c)、hs-CRP、D-D及BNP水平可作为DCM的早期诊断指标,而积极控制血糖和血脂有助于预防DCM的发生。Objective To analyze the early diagnostic index for diabetic cardiomyopathy. Methods From 2013 to 2015, a total of 318 patients with type 2 diabetes mellitus were selected in the Department of Endocrinology, the First Hospital of Baoding, and they were divided into A group （ with reduction of left ventricular diastolic function, n =70） and B group （ with normal cardiac function, n = 248 ） according to color Doppler cardiac ultrasound examination results. Gender, age, occupation, educational level, course of type 2 diabetes mellitus, BMI, FBG, HbA1c, TC, TG, VLDL, LDL, insulin, C- peptide, hs-CRP, D-direct, BNP and UAER were compared between the two groups. Results There were statistically significant differences of gender and occupation between the two groups （ P 〈 0.05 ） , while no statistically significant differences of age or educational level was found between the two groups （ P 〉 0. 05 ）. Course of type 2 diabetes mellitus of A group was statistically significantly longer than that of B group, FBG, HbA1c, TG, VLDL, hs-CRP, D-dimer, BNP and UAER of A group were statistically significantly higher than those of B group （ P 〈 0. 05 ） ; while no statistically significant differences of BMI, TC, LDL, insulin or C - peptide was found between the two groups （ P 〉 0. 05 ）. Multivariate logistic regression analysis results showed that, course of type2 diabetes [OR=1.118, 95%CI （1.007, 1.241）3, HbA1c, [OR=1.859, 95%CI （1.188, 2. 910）], TG [OR= 1.792, 95%CI （1.036, 3.099）], hs-CRP [OR =1.779, 95%CI （1.102, 2. 871）], D-dimer [0R=39.460, 95%CI （2.546, 611. 607）] and BNP IOR=2.072, 95%CI （1.082, 3. 967）] were independent risk factors of diabetic cardiomyopathy （P 〈 0. 05）. Conclusion HbA1c, hs-CRP, D-dimer and BNP may be early diagnostic index for diabetic cardiomyopathy, meanwhile active control of blood glucose and blood liquids plays an important role in the prevention of diabetic cardiomyopatby.

关 键 词：糖尿病 糖尿病心肌病 生物学标记 诊断 

分 类 号：R587.1[医药卫生—内分泌]