老年2型糖尿病肾病患者心功能改变及影响因素分析  

Analysis of cardiac function changes and its influencing factors in elderly patients with type 2 diabetic nephropathy

作　　者：张振兴 张秀楠 蒋翠萍 叶志斌 张音佳[4] 张晓丽 Zhang Zhenxing;Zhang Xiunan;Jiang Cuiping;Ye Zhibin;Zhang Yinjia;Zhang Xiaoli(Department of Nephrology,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China;Department of Nephrology,Songjiang Hospital Affiliated to Shanghai Jiaotong University,School of Medicine,Shanghai,201600;Department of Endocrinology,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China;Department of Ultrasound,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China)

机构地区：[1]复旦大学附属华东医院肾内科,上海200040 [2]上海交通大学医学院附属松江医院肾内科,上海201600 [3]复旦大学附属华东医院内分泌科,上海200040 [4]复旦大学附属华东医院超声医学科,上海200040

出　　处：《老年医学与保健》2024年第2期434-439,共6页Geriatrics & Health Care

基　　金：国家自然科学基金面上项目(82270714)。

摘　　要：目的本研究采用二维斑点追踪应变超声心动图(2D-STE)研究老年2型糖尿病患者心脏功能改变并探索其相关危险因素。方法选取2022年3月-2023年3月经复旦大学附属华东医院确诊的老年2型糖尿病肾病(DN)患者44例、单纯2型糖尿病(DM)患者56例以及老年健康对照20例,收集其临床资料,进行常规超声心动图和2D-STE检查,比较各组间指标差异。采用多因素Logistic回归法分析患者发生亚临床左室收缩功能不全(GLS<18%)的危险因素。结果2D-STE结果显示,老年DN患者E/e和舒张功能不全(E/e>14)发生比例较健康对照组或DM组均有显著增加;与健康对照组或DM组比较,DN组左室整体纵向应变值(GLS)明显下降,亚临床左室收缩功能不全发生比例显著增加,差异有统计学意义。Logistic回归分析显示,蛋白尿、eGFR<60 mL/min/1.73 m^(2)和总胆固醇是老年2型糖尿病患者发生亚临床左室收缩功能不全的危险因素。结论老年DN患者存在舒张功能障碍和GLS评估的亚临床左室收缩功能减退。蛋白尿、eGFR<60 mL/min/1.73 m 2和总胆固醇与老年2型糖尿病患者左室收缩期纵向心肌功能障碍密切相关。Objective To investigate the early changes of cardiac function and related risk factors in elderly patients with type 2 diabetes mellitus(DM)by two-dimensional spot tracking strain echocardiography(2D-STE).Methods From March 2022 to March 2023,44 elderly patients with type 2 diabetic nephropathy(DN),56 DM patients and 20 elderly healthy controls were selected from Huadong Hospital Affiliated to Fudan University.Their clinical data were collected and routine echocardiography and 2D-STE were performed.The index differences were compared among the three groups.Multivariate logistic regression was used to analyze the risk factors for subclinical left ventricular systolic dysfunction(GLS<18%)in patients.Results The 2D-STE results showed that the E/e value and the proportion of diastolic dysfunction(E/e>14)in the DN group were significantly higher than those in the healthy control group or the DM group.Compared with the healthy control group or DM group,the global longitudinal strain(GLS)value of left ventricle of the DN group decreased significantly,and the incidence of subclinical left ventricular systolic dysfunction increased significantly,with statistical significance.Logistic regression analysis showed that albuminuria,eGFR<60 mL/min/1.73 m^(2) and total cholesterol were risk factors for subclinical left ventricular systolic dysfunction in elderly DM patients.Conclusion Elderly DN patients have diastolic dysfunction and subclinical left ventricular systolic dysfunction assessed by GLS.Albuminuria,GFR<60 mL/min/1.73 m 2 and total cholesterol are closely related to left ventricular systolic longitudinal myocardial dysfunction in elderly DM patients.

关 键 词：老年 糖尿病肾病 白蛋白尿 左室收缩功能不全 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]