第12页／亚临床糖尿病心肌病患者微量白蛋白尿与心功能相关性

目的：探讨亚临床糖尿病心肌病患者微量白蛋白尿与Tei指数及其他传统左心室收缩舒张功能指标的相关性。方法：采用彩色多普勒超声诊断仪对正常对照组、2型糖尿病组、2型糖尿病亚临床心肌病伴微量白蛋白尿组及不伴微量白蛋白尿组进行Tei指数和其他左心室收缩舒张功能指标的测定，     

Tei指数评价老年2型糖尿病性心肌病变左室功能的临床研究

目的应用Doppler超声心动图检测左室Tei指数指标评价老年2型糖尿病性心肌病变致左心收缩与舒张的整体综合功能的改变。方法受检对象为老年男性95例,其中无糖尿病史正常老年人30例〔年龄(69.9±3.7)岁〕,组Ⅰ为34例无左室二维结构改变的老年2型糖尿病患者〔年龄(69±4)岁〕,组Ⅱ为31例检出左室壁肥厚、左室扩大等二维结构改变的老年2型糖尿病性心肌病变患者〔年龄(71.0±5.3)岁〕。Doppler超声心动图检测指标包括:左室壁厚度、左室内径及射血分数和主动脉瓣口、二尖瓣口Doppler血流速度及相应的时间测量并计算左室Tei指数。结果组Ⅰ、组Ⅱ分别与正常对照组比较:A峰、E峰、E/A值和Tei指数均有显著性差异,均P<0.05。组Ⅱ分别与组Ⅰ、正常对照组比较:左室壁厚度差异均显著(均P<0.05)。结论左室Tei指数是反映老年2型糖尿病左心整体功能改变的较简便、无创、敏感及准确的指标,可为临床老年2型糖尿病性心肌病变的早期诊治及预后提供依据。     

超声心动图评价高龄高血压患者左心室收缩与舒张功能

目的探讨超声心动图各指标评估高龄老年高血压患者左心室不同构型的收缩与舒张功能的临床价值。方法将高龄老年原发性高血压患者153例,按Ganau法分为4组:正常构型组(47例)、向心性重构型组(35例)、向心性肥厚型组(33例)和离心性肥厚型组(38例);另选无心肺疾病的患者65例为正常对照组。超声心动图测量舒张末期室间隔厚度(IVS)、左心室后壁厚度(LVPW)、左心室内径(LVEDD)、二尖瓣血流频谱图舒张早期与晚期血流峰值比(E/A)、LVEF及Tei指数。结果正常对照组及以上4组E/A均<1;离心性肥厚型组LVEF明显降低(P<0.05),正常构型组、向心性重构型组、向心性肥厚型组比较无显著差异;以上4组Tei指数与正常对照组比较差异有显著性意义(P<0.05),但4组间比较无显著差异,Tei指数和E/A无相关性,Tei指数和LVEF呈负相关(r为-0.594,P<0.001)。结论Tei指数较E/A及LVEF更能全面评价高龄老年高血压患者心脏的收缩和舒张功能。     

甲状腺功能亢进症患者超声心动图左心室应变率与左心室Tei指数的关系

目的:探讨甲状腺功能亢进症患者超声心动图左心室应变率、左心室Tei指数变化特点及其相关性.方法:将入选的98例患者依据甲状腺功能亢进症及甲亢性心脏病诊断标准分为两组,单纯甲亢组(n=52)及甲亢性心脏病组(n=46),另随机选择49例同期健康体检者作为正常对照组.所有受试者均进行体格检查、心电图、超声心动图及实验室检查.结果:正常对照组、单纯甲亢组及甲亢性心脏病组左心室Tei指数(分别为0.35±0.09,0.47±0.09及0.54±0.10)依次显著升高,各组间差异有统计学意义(P均<0.05);正常对照组、单纯甲亢组及甲亢性心脏病组左心室基底段、中间段的舒张早期最大应变率(SRe)、舒张晚期最大应变率(SRa)及收缩期最大应变率(SRs)均依次显著降低,各组间差异有统计学意义(P均<0.05).左心室基底段、中间段的SRs与左心室Tei指数呈负相关(P<0.05),与左心室射血分数、左心室短轴缩短率呈正相关(P<0.05),左心室基底段、中间段的SRe、SRa与左心室Tei指数和左心房收缩(A)峰呈负相关(P<0.05),与舒张早期(E)峰、E/A值呈正相关(P<0.05).结论:甲亢患者在未出现心脏临床症状时,已存在局部左心室壁收缩功能及舒张功能的下降.应变率参数与左心室Tei指数显著相关性.     

非肥胖2型糖尿病患者血清内脂素与不同阶段糖尿病肾病的关联性研究

目的研究非肥胖2型糖尿病患者血清内脂素(visfatin)与尿微量白蛋白/肌酐(ACR)之间的相关性,探讨内脂素在不同阶段糖尿病肾病中的改变。方法收集体重指数(BMI)28 kg/m2的2型糖尿病患者90例,按照尿ACR分为单纯糖尿病组30例(T2DM组,尿ACR30μg/mg),微量蛋白尿组30例(DN1组,尿ACR30~300μg/mg),大量蛋白尿组30例(DN2组,尿ACR300μg/mg),健康体检人员组(对照组)30例,测定血清内脂素及血脂、血糖等生化指标。结果非肥胖2型糖尿病患者组血清内脂素水平显著高于对照组(P0.01),糖尿病肾病患者组血清内脂素水平显著高于单纯糖尿病组(P0.01),其中大量蛋白尿组血清内脂素水平显著高于微量蛋白尿组(P0.01)。血清内脂素与尿ACR水平呈正相关(r=0.558,P0.01)。结论非肥胖的2型糖尿病患者血清内脂素水平升高,与尿ACR密切相关,随着糖尿病肾病加重,内脂素也逐渐升高。内脂素有希望作为糖尿病肾病的治疗靶点。     

正常高值血压人群微量白蛋白尿和小动脉顺应性的变化

目的研究正常高值血压和理想血压人群中微量白蛋白尿和小动脉顺应性(C2)的变化及其影响因素。方法入选正常血压受试者153例,分成两组:理想血压组(n=53)和正常高值血压组(n=100)。检测腰围、身高、体重、坐位血压,晨起静脉空腹血糖、血脂、肝肾功能,尿液肌酐等指标;放射免疫法检测尿液微量白蛋白,计算尿液微量白蛋白与肌酐比(ACR);用HDI CVprofilorDO-2020检测大小动脉顺应性。结果理想血压组和正常高值血压组收缩压、舒张压、脉压和C2、ACR均有明显差异(P<0.05);相关分析显示,收缩压与log C2呈负相关(r=-0.439,P<0.001),与log ACR正相关(r=0.460,P<0.001);log ACR与log C2之间也有明显负相关性(r=-0.461,P<0.001);多元回归分析发现,收缩压是独立影响微量白蛋白尿和C2的指标。结论随血压水平的上升,C2逐渐降低,微量白蛋白尿水平逐渐提高,其水平的提高能一定程度上反映C2的减退;收缩压是影响正常高值血压人群微量白蛋白尿和C2的独立因素。     

2型糖尿病患者尿微量白蛋白与血清甲状腺激素的相关性研究

选取2型糖尿病患者105例,分为糖尿病微量蛋白尿组及糖尿病正常蛋白尿组,设对照组30例,检测血清游离T3(FT3)、游离T4(FT4)、促甲状腺素(TSH)、甲状腺素(T4)、三碘甲状腺原氨酸(T3)、尿微量白蛋白等指标,分析2型糖尿病患者尿微量白蛋白与血清甲状腺激素之间的相关性。结果三组之间FT3、T3、尿微量白蛋、HbA1c的差异有统计学意义(P<0.05),进一步两两比较,DM微量白蛋白尿组的FT3、T3显著低于DM正常蛋白尿组及对照组,尿微量白蛋白、HbA1c显著高于DM正常蛋白尿组及对照组,差异有统计学意义(P<0.05);尿微量白蛋白、FT3与病程有关,随病程的延长,尿微量白蛋白逐渐升高,FT3则逐渐降低,尿微量白蛋白与FT3呈负相关,相关系数为-0.496(P<0.05)。结论糖尿病伴有微量白蛋白尿患者会出现FT3、T3降低,尿微量白蛋白与FT3呈负相关,检测这两项指标对诊断、治疗及评估预后有重要意义。     

2型糖尿病左心室舒张功能减退病人临床特点分析

目的观察2型糖尿病左心室舒张功能减退的临床特征,探讨糖尿病心肌病变的病理过程。方法排除高血压,冠心病的2型糖尿病病人62例,进行心脏B超和组织多普勒检查,以左心室E/A假性正常化和E/A小于1作为左心室舒张功能减退标准,分析2型糖尿病病人左心室舒张功能减退的临床特征以及胰岛素抵抗指数等改变。结果2型糖尿病病人左心室舒张功能减退发生率60%(37/62),左心室舒张功能减退与病人年龄,糖尿病病程,尿白蛋白与肌酐比值和QTc延长相关。结论糖尿病病程和年龄因素可能参与糖尿病心肌病变的病理过程。     

Tei指数在心血管疾病中的应用

Tei指数又称心肌做功指数,最初由日本学者Tei于1995年提出,用于临床综合评价心脏整体收缩和舒张功能[1].该指数测量简便易行,与其他常用评价心脏功能的指标如左室射血分数(LVEF)、舒张早期和舒张晚期血流峰值比值(E/A值)等相比,其不受血压、心律、心脏几何形态、瓣膜反流及超声条件等的影响,重复性好,敏感性高.现将Tei指数在心血管疾病中的应用进展作一综述. 1 Tei指数的概念及原理 Tei指数为心室等容收缩时间(ICT)与等容舒张时间(IRT)之和与心室射血时间(ET)的比,即Tei指数=(ICT+ IRT)/ET.常用脉冲多普勒测量,成人左心室Tei指数正常值为0.38 ±0.05,右室为0.28 ±0.04.心脏发挥正常的收缩、舒张功能依赖于心腔内压力的变化,等容收缩期及等容舒张期内左心室压力变化速率(dp/dt)是反映左心室收缩及舒展弛缓的指标之一[2].     

左心室壁中层缩短率评价2型糖尿病患者早期左心室收缩功能变化

目的:运用左心室壁中层缩短率评价2型糖尿病患者早期左心室收缩功能改变.方法:51例2型糖尿病者(糖尿病组)及30例体验正常者(对照组),行常规及组织多普勒超声心动图检查,测量左心室壁中层缩短率(mFS),计算左心室经线及圆周收缩末期应力,对两组间左心室结构和收缩功能指标即mFS、左心室射血分数、左心室短轴缩短率(LVFS)和二尖瓣环收缩期峰值运动速度(Sm)进行比较,并对mFS与左心室结构参数、空腹血糖水平行相关分析.结果:糖尿病组与对照组比较,左心室舒张末径、左心室收缩末径、左心室质量、左心室心肌质量指数均增加(P<0.01),mFS减低[(21.9±3.4)% vs (24.2±2.6)%,P<0.01].两组间舒张期室间隔厚度、舒张期左心室后壁厚度及相对室壁厚度比较,差异无统计学意义.mFS与左心室收缩末径、左心室质量、左心室心肌质量指数负相关(r 值分别为-0.586、-0.332和-0.239,P<0.05),与空腹血糖水平亦呈负相关 (r =-0.315,P=0.011),这种负相关在校正了年龄、性别、收缩压和体重指数的影响后仍然存在.结论:2型糖尿病患者存在亚临床的左心室收缩功能变化,室壁中层缩短率是检测糖尿病患者早期心肌收缩力下降的敏感指标.     

Left ventricular mass and systolic function in African diabetic patients: association with microalbuminuria.

OBJECTIVE: To assess echocardiographic evidence of cardiomyopathy and its association with microalbuminuria in type 2 normotensive non-proteinuric diabetic patients. MATERIAL AND METHODS: Forty consecutive normotensive non-proteinuric type 2 diabetic patients were studied. Body mass index, blood pressure, urinary albumin excretion, ECG at rest and after exercise, left ventricular mass, and shortening fraction using two-dimensional and M-mode echocardiography were measured in every patient. RESULTS: Among the 40 patients studied, 17 (42.5%) presented with microalbuminuria, 16 (40.0%) with left ventricular hypertrophy, 22 (55.0%) with systolic dysfunction and 3 (7.5%) with ECG changes compatible with cardiac ischaemia. No significant difference existed between normoalbuminuric and microalbuminuric patients for age, known duration of diabetes, body mass index, systolic and diastolic blood pressure. Ventricular mass correlated to urinary albumin excretion rate (r=0.34; p=0.04) and shortening fraction to diastolic blood pressure (r = - 0.40; p=0.01). CONCLUSION: Left ventricular structure and function might be altered in African type 2 diabetic patients in the absence of hypertension, and microalbuminuria may be an early biochemical marker of these abnormalities.     

Alterations in l-arginine and inflammatory markers in type 2 diabetic patients with and without microalbuminuria

Low-grade inflammation is closely involved in the pathogenesis of type 2 diabetes and associated micro- and macrovascular complications. The nitric oxide (NO) precursor l-arginine, is relevant to diverse pathological conditions including type 2 diabetes and its complications. High sensitive-CRP (hs-CRP), neopterin and arginine levels were measured in 46 normoalbuminuric, 45 microalbuminuric type 2 diabetics and in 32 healthy controls in order to assess the relationship between markers of inflammation and l-arginine. Hs-CRP concentrations were higher in microalbuminuric diabetic patients compared to normoalbuminuric patients and controls. Diabetics had higher serum and urine neopterin levels than controls. Urine neopterin and l-arginine levels differed significantly among diabetic patients with and without microalbuminuria. There were significant positive correlations between hs-CRP and BMI in healthy controls and diabetics with and without microalbuminuria. In microalbuminuric diabetics, hs-CRP correlated with microalbuminuria (MAU). Significant predictors for the development of microalbuminuria were higher postprandial glucose levels, lower creatinine clearance and lower serum l-arginine levels. Assessment of early markers of inflammation and endothelial function, such as neopterin and NO precursor l-arginine, may help to predict incipient nephropathy more accurately in type 2 diabetic patients.     

限蛋白质摄入对2型糖尿病早期肾病的影响

目的 评估限蛋白质摄入对２型糖尿病肾病在肾功能和营养状况方面的影响。方法 门诊６７例早期肾病病人,按就诊顺序分为限蛋白治疗组和正常蛋白组,试验期为１年。结果 两组病人体重指数、血常规及血液生化、血糖指标、血液肾功能治疗后无显著性差异。治疗组两组间血清白蛋白有显著性差异。实验组尿白蛋白排泄率明显下降。结论 限蛋白膳食可以显著减少２型糖尿病早期肾病病人尿白蛋白排泄率,从而改善营养状况,保护肾功能。     

2型糖尿病微量白蛋白尿与氧化应激的关系

目的探讨2型糖尿病患者微量白蛋白尿与氧化应激状态的关系。方法将72例2型糖尿病患者分为无微量白蛋白尿的糖尿病组（DM组）和伴有微量白蛋白尿的糖尿病肾病组（DN组）,选择30例无糖尿病患者作正常对照组（NGT组）,测定三组的血清丙二醛（MDA）水平、生化指标及年龄、身高、体质量指数。结果DN组MDA水平明显高于NGT组及DM组,MDA水平与尿微量白蛋白排泄率（UAER）有显著相关性。结论与无微量白蛋白尿的糖尿病患者相比,糖尿病肾病患者存在着严重的氧化应激状态,这可能与UAER的严重程度相关。     

Microalbuminuria and risk factors in type 1 and type 2 diabetic patients

A prospective study of normoalbuminuric diabetic patients was performed between 1997 and 2002 on 4097 type 1 and 6513 type 2 diabetic patients from the Swedish National Diabetes Register (NDR); mean study period, 4.6 years. The strongest independent baseline risk factors for the development of microalbuminuria (20-200 microg/min) were elevated HbA(1c) and diabetes duration in both types 1 and 2 diabetic patients. Other risk factors were high BMI, elevated systolic and diastolic BP in type 2 patients, and antihypertensive therapy in type 1 patients. A subsequent larger cross-sectional study in 2002 showed that established microalbuminuria was independently associated with HbA(1c), diabetes duration, systolic BP, BMI, smoking and triglycerides in types 1 and 2 diabetic patients, and also with HDL-cholesterol in type 2 patients. Relatively few types 1 and 2 patients with microalbuminuria achieved treatment targets of HbA(1c) < 6.5% (21-48%), BP < 130/85 mmHg (33-13%), cholesterol < 5 mmol/l (48-46%), triglycerides < 1.7 mmol/l (83-48%) and BMI < 25 kg/m(2) (50-18%), respectively. In conclusion, high HbA(1c), BP and BMI were independent risk factors for the development of microalbuminuria in types 1 and 2 diabetic patients. These risk factors as well as triglycerides, HDL-cholesterol and smoking were independently associated with established microalbuminuria. Treatment targets were achieved by a relatively few patients with microalbuminuria.     

Nitric oxide modulation of renal and cardiac hemodynamics in type 2 diabetes

OBJECTIVE: To evaluate endothelial function in type 2 diabetic patients with and without diabetic nephropathy. METHODS: We studied the effects of systemic infusion of the nitric oxide (NO) synthase inhibitor NG-monomethyl-l-arginine (L-NMMA) on cardiovascular and renal hemodynamics in six type 2 diabetic patients with microalbuminuria (D2-MA), six type 2 diabetic patients with normoalbuminuria (D2-NA) and five control subjects. Both type 2 diabetic patients and control subjects had mild arterial hypertension. RESULTS: L-NMMA infusion decreased the cardiac index in all groups. A reduction in glomerular filtration rate (GFR) and an increase in filtration fraction were observed only in controls. Renal plasma flow decreased in controls and D2-NA patients and renal vascular resistance increased in all groups. CONCLUSIONS: The effect of L-NMMA on cardiac output was similar in controls and type 2 diabetic patients with and without diabetic nephropathy. In contrast, the effect on GFR was impaired in both diabetic groups, suggesting that glomerular NO homeostasis is altered in type 2 diabetes. Moreover the discrepancy, in diabetic patients, between cardiac and renal effects during L-NMMA infusion suggests that the modulation of glomerular hemodynamics is independent from NO-regulated cardiac output.     

Microalbuminuria in a population of 653 patients with type 1 and 2 diabetes]

The aim of this retrospective study was to evaluate the prevalence of microalbuminuria in type 1 and 2 diabetic patients with or without high blood pressure levels. 653 patients were involved in the study [type 1: n = 413 (normotensive: n = 298; hypertensive: n = 115); type 2: n = 240 (normotensive: n = 93; hypertensive: n = 147)]. In type 1 diabetic patients, the prevalence of microalbuminuria was of 21 per cent. Microalbuminuria was also found in 28 per cent of type 2 diabetic subjects (p less than 0.10 vs type 1). The prevalence of microalbuminuria was significantly higher in hypertensive than in normotensive diabetic subjects (28 vs 20 per cent; p less than 0.05). Blood pressure in type 1 and 2 normotensive patients was significantly higher in subjects with than without microalbuminuria. We also observed higher HbA1 levels in microalbuminuric type 1 diabetic patients. Finally, we also assessed that the prevalence of diabetic chronic complications was higher in type 1 patients with than without microalbuminuria (p less than 0.05). This relationship was not evidenced in type 2 diabetic patients. In conclusion, the prevalence of microalbuminuria in a population of type 1 and 2 diabetic patients is high. We confirm in this study the relationship between microalbuminuria, blood pressure, and HbA1.     

Left ventricular diastolic dysfunction in young people with type 1 diabetes mellitus. Associated factors

AIM: The aim of our study was to evaluate left ventricular function of diastolic in young (< 40 years) asymptomatic patients with type 1 diabetes mellitus free of cardiovascular disease symptoms and to analyze the associated factors to the left ventricular diastolic dysfunction (LVDD) in these patients. PATIENTS AND METHODS: Thirty-five type-1 diabetic patients (mean age 27.8+/-7.5 years) old and 54 healthy controls (mean age 26.1+/-4.1 years) were studied. Anamnesis, physical exploration, general analytical studies, microalbuminuric and Doppler-echocardiographic studies were performed. RESULTS: The LVDD was present in 13 (37.1%) of the diabetic patients and none of the control patients. The ratio of peak early to peak late (atrial) filling velocity was significantly decreased in diabetic compared with control subjects (1.1+/-0.3 versus 1.5+/-0.2; p<0.01). The isovolumetric relaxation time was increased in diabetic patients compared with control subjects (104+/-11 versus 79+/-11; p<0.01). Diabetics with LVDD were older aged, predominantly males, had worse glucemic control, more alteration of lipidic metabolism and higher levels of microalbuminuria, than diabetics without LVDD. CONCLUSIONS: The LVDD is frequent in young diabetics free of cardiovascular disease symptoms. These studies suggest that because this patients were of older age, of the masculine sex with, poor glucemic control, altered lipidic metabolism, and microalbuminuria they might be a group that is associated with LVDD which, in the absence of cardiovascular disease, might be an early preclinical alteration, potentially related to subsequent development of diabetic cardiomyopathy.     

Cardiovascular risk profile and morbidity in subjects affected by type 2 diabetes mellitus with and without diabetic foot

Diabetic foot syndrome (DFS) is the most frequent cause of hospitalization of diabetic patients and one of the most economically demanding complications of diabetes. People with diabetes have been shown to have higher mortality than people without diabetes. On this basis, the aim of our study was to evaluate the possible role of diabetic foot as a cardiovascular risk marker in patients with type 2 diabetes mellitus. We enrolled 102 consecutive patients with type 2 diabetes mellitus with diabetic foot and 123 patients with type 2 diabetes mellitus without limb lesions to compare the prevalence of main cardiovascular risk factors, subclinical cardiovascular disease, previous cardiovascular morbidity, and incidence of new vascular events on a 5-year follow-up. Diabetic patients with diabetic foot were more likely to have a higher prevalence of cardiovascular risk factors such as hypercholesterolemia, hypertriglyceridemia, hyperuricemia, and microalbuminuria or proteinuria, a higher prevalence of a previous cardiovascular morbidity (coronary artery disease, transient ischemic attack/ischemic stroke, diabetic retinopathy), and a higher prevalence of subclinical cardiovascular disease. Furthermore, diabetic patients with foot ulceration showed, on a 5-year follow-up, a higher incidence of new-onset vascular events (coronary artery disease, transient ischemic attack/ischemic stroke, diabetic retinopathy). At multivariate analysis, duration of diabetes, age, hemoglobin A1c, and DFS maintained a significant association with cardiovascular morbidity; but DFS presence showed the highest hazard ratio.     

Heparanase activity as a prospective marker for diabetic nephropathy in Egyptian patients with type 2 diabetes mellitus

The objective of this study is to investigate the possible association between heparanase activity and diabetic and renal biomarkers to evaluate heparanase as a predictor of diabetic nephropathy in type 2 Egyptian diabetic patients. Eighty four volunteers were classified as follows: group I comprised 28 normal subjects, group II consisted of 28 type 2 diabetic patients with normoalbuminuria, and group III consisted of 28 type 2 diabetic patients with microalbuminuria. Heparanase activity in the urine and serum, diabetic biomarkers, and renal function tests were determined. Type 2 diabetic patients with normoalbuminuria exhibited a significant increase in serum heparanase activity (39.19 %); this increase was augmented in patients with microalbuminuria (122.2 %), compared to normal control. Elevation in serum heparanase activity was parallel with the levels of diabetic biomarkers. Urinary heparanase activity showed a significant increase in the type 2 diabetic patients with normoalbuminuria (49.14 %), while kidney function biomarkers were insignificantly changed with exception to a significant decrease in urinary creatinine (14.24 %), compared to normal control. On the other hand, diabetic patients with microalbuminuria showed a dramatic increase in urinary heparanase activity with a significant increase in all kidney function biomarkers, together with a highly significant decrease in creatinine and estimated glomerular filtration rate (eGFR) compared to those with normoalbuminuria. Significant positive correlation between serum heparanase activity and plasma glucose, insulin, and homeostasis model assessment for insulin resistance (HOMA-IR) as well as urinary heparanase activity and albuminuria was reported. Also, a significantly negative correlation was found between urinary heparanase and urinary creatinine and eGFR. Heparanase activity may serve as a potential predictor for diabetic nephropathy in type 2 diabetic patients with uncontrolled glucose tolerance. Therefore, the use of heparanase for early diagnosis in addition to good glycemic control would be more effective in reducing the risk of diabetic renal complications.