2型糖尿病患者亚临床左心室收缩功能与糖尿病微血管并发症的相关性研究  

Correlation between Subclinical Left Ventricular Systolic Function and Diabetic Microvascular Complications in Patients with Type 2 Diabetes

作　　者：陈艳艳 石敏 王奕 付建芳 张颖 刘向阳 张伟清 拓胜军 刘丽文 李泽平 周洁 李晓苗 CHEN Yanyan;SHI Min;WANG Yi;FU Jianfang;ZHANG Ying;LIU Xiangyang;ZHANG Weiqing;TA Shengjun;LIU Liwen;LI Zeping;ZHOU Jie;LI Xiaomiao(Department of Endocrinology,the First Affiliated Hospital of Air Force Medical University,Xi'an 710032,China;Department of Ultrasound,the First Affiliated Hospital of Air Force Medical University,Xi'an 710032,China;Nanchang University Queen Mary School,Nanchang 330038,China;Department of Internal Medicine,the First Affiliated Hospital of Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院内分泌科,陕西省西安市710032 [2]空军军医大学第一附属医院超声科,陕西省西安市710032 [3]南昌大学玛丽女王学院,江西省南昌市330038 [4]空军军医大学第一附属医院内科学教研室,陕西省西安市710032

出　　处：《中国全科医学》2023年第35期4412-4418,共7页Chinese General Practice

基　　金：国家自然科学基金资助项目(82070839);陕西省基础研究计划重点项目(2020JZ-31)。

摘　　要：背景近年来,有研究证实超声斑点追踪技术可用于早期评价2型糖尿病(T2DM)患者亚临床左心室收缩功能。此外,长期暴露于高血糖环境严重损害全身微血管系统,然而,有关糖尿病微血管并发症与亚临床左心室收缩功能相关性的认识尚未完全清楚。目的探讨T2DM患者亚临床左心室收缩功能与糖尿病微血管并发症的关系。方法收集2021年6—12月于空军军医大学第一附属医院内分泌科住院的150例T2DM患者,其均行常规超声心动图、脉冲组织多普勒超声及二维斑点追踪超声心动图(STE)检查。获取左心室二维整体纵向应变(GLS),评估亚临床左心室收缩功能。糖尿病微血管并发症定义为合并糖尿病视网膜病变、糖尿病肾脏疾病或糖尿病周围神经病变。受试者根据微血管并发症受累数目分为单纯T2DM组(单纯T2DM组,n=76)、T2DM伴1种并发症组[T2DM+C(1)组,n=37]和T2DM伴2~3种并发症组[T2DM+C(2~3)组,n=37]。比较三组患者一般人口学特征及生化指标。利用相关性分析、Logistic回归分析评估微血管并发症和亚临床左心室收缩功能的关系。结果T2DM+C(1)组、T2DM+C(2~3)组GLS低于单纯T2DM组(P<0.05)。Spearman秩相关分析结果显示,糖尿病微血管并发症受累数目与GLS呈负相关(rs=-0.349,P<0.001)。Logistic回归分析结果显示,经性别、年龄、糖尿病病程、高血压、糖化血红蛋白、空腹血糖、血肌酐、心率、尿微量白蛋白、左心室缩短分数多因素调整后,与单纯T2DM组相比,T2DM+C(1)组[OR=0.744,95%CI(0.601,0.920)]、T2DM+C(2~3)组[OR=0.707,95%CI(0.525,0.952)]GLS降低(P<0.05)。基于高血压分层的多因素Logistic回归分析结果显示,经校正上述相同的混杂因素后,无论在有或无高血压的T2DM患者中,糖尿病微血管并发症与GLS降低仍独立相关[有高血压:OR=0.556,95%CI(0.321,0.963);无高血压:OR=0.739,95%CI(0.558,0.979),P<0.05]。结论住院T2DM合并微血管病变的患者左心Background In recent years,studies have demonstrated the use of ultrasound speckle tracking techniques for the early evaluation of subclinical left ventricular(LV)systolic function in patients with type 2 diabetes mellitus(T2DM).In addition,long-term exposure to hyperglycemia severely damages the microvascular system.However,the interaction between diabetic microvascular complications and subclinical LV systolic function has not been fully understood.Objective To investigate the relationship between subclinical LV systolic function and diabetic microvascular complications in patients with T2DM.Methods A total of 150 patients with T2DM who were admitted to the Department of Endocrinology,the First Affiliated Hospital of Air Force Medical University from June to December 2021 were selected in the cross-sectional study and all underwent conventional echocardiography,pulsed tissue Doppler echocardiography and two-dimensional speckle tracking echocardiography(2D STE).The 2D global longitudinal strain(GLS)of LV was obtained to assess the subclinical LV systolic function.Diabetic microvascular complications were defined as combined diabetic retinopathy,diabetic kidney disease or peripheral neuropathy.The subjects were divided into the T2DM alone group(T2DM alone group,n=76),the T2DM with 1 complication group[T2DM+C(1)group,n=37]and the T2DM with 2 to 3 complications group[T2DM+C(2 to 3)group,n=37]according to the cumulative number of microvascular complications.The general demographic characteristics and biochemical indices of patients in the three groups were compared.The relationship between microvascular complications and subclinical LV systolic function was assessed by using Spearman correlation analysis and Logistic regression analysis.Results GLS was lower in the T2DM+C(1)and T2DM+C(2 to 3)groups than in the T2DM alone group(P<0.05).Spearman rank correlation analysis showed that the number of diabetic microvascular complications involved was negatively correlated with GLS(rs=-0.349,P<0.001).Logistic regression ana

关 键 词：糖尿病 2型 糖尿病微血管并发症 整体纵向应变 亚临床左心室心肌损伤 

分 类 号：R587.1[医药卫生—内分泌]