研究血清胆红素对2型糖尿病患者心脏结构发生改变前心肌功能的影响  

Effect of serum bilirubin on myocardial function in patients with type 2 diabetes before cardiac structural changes

作　　者：薛念余[1,2] 张盛敏 吴凌恒[2,3] 沙蕾 童揽月 沈崔琴 李朝军 杜联芳[2] Nianyu Xue;Shengmin Zhang;Lingheng Wu;Lei Sha;Lanyue Tong;Cuiqin Shen;Zhaojun Li;Lianfang Du(Department of Ultrasound,the Ningbo First Hospital,Ningbo 31010,China;Department of Ultrasound,Shanghai General Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200080,China;Department of Ultrasound,Mindong Hospital Affiliated to Fujian Medical University,Ningde 355000,China;Department of Ultrasound,Jiading Branch of Shanghai General Hospital,Shanghai 208038,China)

机构地区：[1]宁波市第一医院超声科,宁波315010 [2]上海交通大学附属第一人民医院超声医学科,上海200080 [3]福建医科大学附属闽东医院超声科,宁德55000 [4]上海市第一人民医院嘉定分院超声科,上海208038

出　　处：《中华临床医师杂志（电子版）》2023年第9期1004-1009,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：上海市自然科学基金(21ZR1451400);上海市嘉定区卫生和计划生育委员会基金(2021-KY-10)。

摘　　要：目的研究2型糖尿病患者心脏结构发生改变前,血清胆红素对其心肌功能的影响。方法选取符合入选标准的2型糖尿病受试者89例作为糖尿病组,随机选取2020年12月~2022年6月于上海市第一人民医院嘉定分院就诊的无糖尿病和心脑血管疾病史的受试者67例为对照组。分别获取受试者年龄、体质量指数(BMI)、收缩压(SBP)、总胆固醇(TC)、总甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、空腹血糖(FPG)、总胆红素(TBIL)、直接胆红素(DBIL)和间接胆红素(IBIL);左心室舒张末期(LVEDD)和收缩末期内径(LVESD)、室间隔厚度(IVSD)、左心室后壁厚度(LVPWD);E/e'、e'/a'、左心室射血分数(LVEF)、左心室心肌分层环向应变(GCSendo、GCSmid和GCSepi)等。比较两组之间各项指标的差异;采用多因素相关分析胆红素与血生化指标及左心室结构和功能指标的相关性。结果与对照组相比,糖尿病组受试者的年龄、BMI、SBP、TG、FPG和IBIL均较大(P均<0.05)。与对照组相比,糖尿病组受试者左心室舒张功能受损,E/e'较高,而e'/a'较低(P均<0.05),糖尿病组受试者左心室心肌分层环向应变指标GCSendo、GCSmid和GCSepi均较低(P均<0.05)。多因素线性回归分析提示:GCSmid、GCSepi是TBIL、DBIL、IBIL独立影响因素(P均<0.05);HDL和血红蛋白是TBIL的独立影响因素(P均<0.05);LDL是DBIL独立影响因素(P<0.05);血红蛋白是IBIL独立影响因素(P<0.05)。Bland-Altman分析显示心肌分层环向应变测量重复性较好。结论心肌分层环向应变可以早期发现糖尿病患者心肌受损,胆红素对糖尿病早期心肌损害有保护作用。ObjectiveTo preliminarily study the effect of serum bilirubin on myocardial function in patients with type 2 diabetes before cardiac structural changes.MethodsEighty-nine patients with type 2 diabetes mellitus who met the inclusion criteria were selected as a diabetes group, and 67 subjects without a history of diabetes mellitus or cardiovascular and cerebravascular diseases were randomly selected from those who visited Jiading Branch of Shanghai First People's Hospital from December 2020 to June 2022 as a control group. The subjects' age, body mass index (BMI), systolic blood pressure (SBP), total cholesterol (TC), total triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), fasting plasma glucose (FPG), total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL);left ventricular end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD), interventricular septal dimensions (IVSD), and left ventricular posterior wall dimensions (LVPWD);and E/e', e'/a', left ventricular ejection fraction (LVEF), and left ventricular myocardial layered circumferential strain (GCSendo, GCSmid, and GCSepi) were compared between the two groups. Multivariate correlation analysis was used to analyze the correlation of bilirubin with blood biochemical indexes and left ventricular structure and function indexes.ResultsCompared with the control group, the subjects in the diabetes group were older in age and had higher BMI, SBP, TG, FPG, and IBIL;had impaired left ventricular diastolic function, higher E/e', and lower e'/a';and had lower GCSendo, GCSmid, and GCSepi (P<0.05 for all). Multivariate linear regression analysis showed that GCSmid and GCSepi were independent influencing factors of TBIL, DBIL, and IBIL;HDL and hemoglobin were independent influencing factors of TBIL;LDL was an independent influencing factor of DBIL;and hemoglobin was an independent influencing factor of IBIL (P<0.05 for all). Bland-Altman analysis showed that the measurement repeatability of the circumferential str

关 键 词：超声心动图 2型糖尿病 胆红素 环向应变 二维斑点追踪技术 

分 类 号：R587.1[医药卫生—内分泌] R542.2[医药卫生—内科学]