肥胖对2型糖尿病患者临床特征及心脏结构功能的影响

目的 探讨肥胖对2型糖尿病患者心脏结构和功能的影响. 方法 符合WHO1999年糖尿病诊断标准的住院2型糖尿病患者270例.根据2000年亚太地区肥胖诊断标准将所有患者分为非肥胖组和肥胖组.使用M型超声心动图检测升主动脉内径(AOD)、左房内径(LAD)、左室收缩期内径(LVDs)、左室舒张期内径(LVDd)、室间隔厚度(IVS)、左室后壁厚度(LVPW)、左室短轴缩短率(FS)、射血分数(EF),采用多普勒超声检测二尖瓣E峰与A峰比值(E/A). 结果 (1)肥胖组体质量、体表面积、舒张压、空腹胰岛素、餐后胰岛素、空腹C肽、胰岛素抵抗指数(HOMA-IR)及三酰甘油高于非肥胖组,非肥胖组糖化血红蛋白及空腹血糖高于肥胖组；(2)肥胖组LAD.IVS、LVPW、左心室质量及E/A比值＜1的发生率高于非肥胖组；(3)多元逐步回归分析:非肥胖组EF与体质量指数呈负相关；肥胖组EF与收缩压呈正相关,与胆固醇、左心室质量(LVM)、空腹胰岛素呈负相关.结论 肥胖糖尿病患者存在明显左心肥大、左心舒张功能异常,与胰岛素抵抗、高三酰甘油血症并存.

Clinical characteristics, cardiac structure and function in obese patients with type 2 diabetes

Objective To investigate the effects of obesity on cardiac structure and function in patients with type 2 diabetes. Methods 270 patients with type 2 diabetes were divided into obese and non-obese groups. HOMA-IR was used to reflect insulin resistance. The cardiac structure was assayed by ultrasonic cardiogram equipment. E/A was used to estimate the left ventricular diastolic function. Results The levels of diastolic pressure, fasting insulin, postprandial insulin, fasting C peptide, HOMA-IR and triglyceride were higher,and HbA1c and fasting blood glucose were lower in obese group compared with non-obese group. The left atria diameter,interventricular septal thickness,post wall thickness of left ventricle,left ventricular mass and the incidence of E/A>1 were higher in obese group. Multiple liner regression showed that EF was positively correlated to BMI in non-obese group, but positively correlated to systolic pressure and negatively correlated to total cholesterol, left ventricular mass, fasting insulin in obese group. Conclusions Apparent left ventricle and atria hypertrophy exist in obese group; and obese patients are susceptible to left ventricular diastolic dysfunction with insulin resistance and hypertriglyceridemia.