2型糖尿病患者胰岛β细胞功能、炎性因子与心功能的相关性研究

目的:分析2型糖尿病(T2DM)患者胰岛β细胞功能、炎性因子与心功能的关系。方法:选取T2DM患者1 879例,包括首次住院1 515例和重复住院364例。比较首次住院T2DM患者不同胰岛β细胞功能指数(HOMA-β)、超敏C反应蛋白(hs-CRP)、红细胞沉降率(ESR)、肿瘤坏死因子-α(TNF-α)水平下E/A比值<1的患病率,采用Logistic回归分析E/A比值<1的相关危险因素,并对其中重复住院患者进行COX回归分析。结果:与心脏舒张功能正常患者比较,首次住院的心脏舒张功能异常患者在性别、年龄、病程、腰围(WC)、高密度脂蛋白胆固醇(HDL-C)、hs-CRP、ESR、3 h C肽(3 h-CP)方面比较差异有统计学意义(P<0.05或P<0.01)。随着HOMA-β、TNF-α水平升高,各组心脏舒张功能异常率均未见明显变化(P>0.05);随着hs-CRP水平、ESR的升高,心脏舒张功能异常情况总体呈上升趋势,且各组间心脏舒张功能异常率比较差异有统计学意义(P<0.01)。Logistic回归分析显示,hs-CRP、ESR是T2DM患者心脏舒张功能异常的影响因素。COX回归分析显示,ESR对重复住院的T2DM患者有重要影响,可作为预测心脏舒张功能异常的危险因素。结论:T2DM患者炎性浸润状态及部分炎性因子可能与心脏舒张功能异常的发生、发展有关,并对患者生存结局有重要影响。

Study on the correlation between islet beta cell function,inflammatory factors and cardiac function in patients with T2DM

Objective:To analyze the relationships between islet beta cell function,inflammatory factors and cardiac function in patients with type 2 diabetes mellitus (T2DM).Methods:Totally 1 879 T2DM patients were collected,including 1 515 cases first admitted in hospital and 364 cases repeatedly admitted in hospital.The prevalence of E/A ratio ＜ 1 in T2DM patients with different levels of islet beta cell function index (HOMA-β),hyper-sensitivity C reactive protein (hs-CRP),erythrocyte sedimentation rate (ESR) and tumor necrosis factor-α (TNF-α).The risk factors related to E/A ratio ＜ 1 was analyzed using Logistic regression analysis.For the patients repeatedly admitted in hospital,COX regression analysis was conducted.Results:There was statistical significance between the patients with normal cardiac diastolic function and those with abnormal cardiac diastolic function who first admitted in hospital in terms of gender,age,course of disease,waist circumference (WC),high-density lipoprotein cholesterol (HDL-C),hs-CRP,ESR and 3-hour C peptide (3 h-CP) (P ＜0.05 or P ＜0.01).The abnormal rates of cardiac diastolic function were not changed obviously among each group as increased HOMA-β and TNF-α level (P ＞ 0.05).The abnormal rates of cardiac diastolic function were on the rise as increased hs-CRP level and ESR,and there was statistical significance among each group regarding the abnormal rates of cardiac diastolic function (P ＜ 0.01).Logistic regression analysis revealed that both hs-CRP and ESR were influencing factors of abnormal cardiac diastolic function.COX regression analysis displayed that ESR had great impact on T2DM patients repeatedly admitted in hospital,and it could be a risk factor to predict abnormal cardiac diastolic function.Conclusion:The inflammatory infiltration and partial inflammatory factors in T2DM patients may be associated with the occurrence and progression of abnormal cardiac diastolic function,and may be have great impact on the patients' survival.