射血分数保留的心力衰竭合并2型糖尿病患者左室收缩功能受损性别差异的研究  

Gender differences in left ventricular systolic dysfunction in patients with heart failure with preserved ejection fraction and type 2 diabetes mellitus

作　　者：梁丽媚 何鑫 赵世光[1] 张会欣[1] 刘红利 王曼 LIANG Limei;HE Xin;ZHAO Shiguang(Department of Ultrasound,Second Hospital of Shijiazhuang City,Shijiazhuang 050051,China)

机构地区：[1]石家庄市第二医院超声科,050051 [2]石家庄市第二医院内分泌科,050051 [3]石家庄市第二医院心内科,050051

出　　处：《中国糖尿病杂志》2024年第9期646-651,共6页Chinese Journal of Diabetes

基　　金：河北省医学科学研究课题计划(20231628)。

摘　　要：目的 探讨射血分数保留的心力衰竭(HFp EF)合并T2DM患者左室收缩功能受损的性别差异。方法 选取2019年1月至2023年6月于石家庄市第二医院内分泌科、心内科门诊或住院治疗的HFp EF患者228例,根据是否合并T2DM分为单纯HFp EF组[女性组(n=61),男性组(n=73)]和HFp EF+T2DM组[女性组(n=49),男性组(n=45)]。测量各组常规超声心动图及左室整体纵向应变(GLS),比较左室结构和功能的性别差异,多元线性回归分析HFp EF合并T2DM患者及HFp EF男性、女性患者GLS受损的影响因素。结果 HFp EF组女性左室质量指数(LVMI)低于男性(P<0.05)。HFp EF+T2DM组女性左室重构率高于本组男性和HFp EF组女性,GLS低于本组男性和HFp EF组女性(P<0.05)。HFp EF、HFp EF+T2DM组女性二尖瓣口舒张期早期峰值速度/二尖瓣环室间隔侧舒张早期的峰值速度高于男性(P<0.05)。多元线性回归分析显示,年龄、女性、Hb A1c、LVMI是HFp EF合并T2DM患者GLS受损的影响因素,年龄、T2DM、NT-pro BNP、LVMI是HFp EF女性患者GLS受损的影响因素,年龄、BMI、冠心病史、NT-pro BNP、LVMI是HFp EF男性患者GLS受损的影响因素。结论 HFp EF合并T2DM患者左室收缩功能受损存在性别差异,女性患者受损程度较男性更严重。Objective To investigate sex‐related differences in left ventricular systolic dysfunction in heart failure with preserved ejection fraction(HFpEF)and type 2 diabetes mellitus(T2DM).Methods A total of 228 HFpEF patients who were treated in the Department of Endocrinology and Cardiology of the Second Hospital of Shijiazhuang from January 2019 to June 2023 were enrolled.They were divided into HFpEF group[women(n=61),men(n=73)]and HFpEF+T2DM group[women(n=49),men(n=73)]according to whether they had T2DM.Conventional echocardiography and left ventricular global longitudinal strain(GLS)data were measured.Sex‐related differences of left ventricular structure and function were compared between the two groups.Multivariable linear regression analysis was performed for the determinants of impaired left ventricular GLS for HFpEF with T2DM patients and HFpEF patients of both sexes.Results LVMI was lower in women than in men in HFpEF group(P<0.05).The left ventricular remodeling rate of women was higher in HFpEF+T2DM group than that of men and women in HFpEF group,and the GLS of women was lower than that of men and women in HFpEF group(P<0.05).The E/E’was higher in women than in men in HFpEF and HFpEF+T2DM groups(P<0.05).Multivariable linear regression analysis showed that age,women,HbA1c and LVMI were the determinants of GLS impairement in HFpEF patients with T2DM.Age,T2DM,NT‐proBNP and LVMI were the determinants of GLS impairement in HFpEF women patients,where as age,BMI,CHD,NT‐proBNP and LVMI werethe determinants of GLS impairement in HFpEF men patients. Conclusions There are sex ‐ relateddifferences in left ventricular systolic dyfunction in HFpEF with T2DM patients. With T2DM exerting agreater adverse effect onleft ventricular systolic dyfunction in women with HFpEF than men.

关 键 词：射血分数保留的心力衰竭 糖尿病 2型 左室收缩功能 

分 类 号：R541.6[医药卫生—心血管疾病] R587.2[医药卫生—内科学]