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心力衰竭是一种心脏结构或功能异常所致的临床综合征,据推测目前中国心血管病患者人数为2.9亿,其中心力衰竭占据450万。依据左心室射血分数,心力衰竭又分为射血分数降低性心力衰竭(HFrEF)和射血分数保留性心力衰竭(HFpEF)。近年来,HFpEF的发病率明显较HFrEF增加且已成为研究的热点。高血压、糖尿病和冠心病是常见能导致心力衰竭的基础疾病,其中糖尿病是最常见合并症之一。在美国,糖尿病在HFpEF中的患病率约为45%,但人们对这一人群的特征和结果了解甚少,在中国更是这样。现总结几项HFpEF治疗临床试验的数据,这些数据都表明糖尿病与HFpEF的发病率和长期死亡率增加有关,并讨论了HFpEF和糖尿病中的几种常见病理机制,包括钠潴留、代谢紊乱、骨骼肌功能受损和潜在的治疗靶点。随着对合并HFpEF和糖尿病的理解的增加,希望能为临床医生更好地提供有效的治疗方法。 相似文献
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目的 观察二甲双胍联合对症治疗对射血分数保留心力衰竭合并2型糖尿病患者的疗效.方法 选择2018年6月—2019年5月在该院内科就诊及住院治疗的65例射血分数保留心力衰竭合并2型糖尿病患者,随机分为治疗组(33例)和对照组(32例).两组均给予降压、螺内酯利尿、及单硝酸异山梨酯、西地兰等药物对症治疗,治疗组同时给予二甲... 相似文献
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【摘要】目的 糖尿病是冠心病临床预后的独立危险因素之一,有研究表明合并糖尿病的冠心病患者行冠脉搭桥（CABG）术后的远期死亡率较未合并糖尿病患者更高[1],糖尿病也是CABG术后移植血管狭窄的独立危险因素之一[2] ,也有研究表明死亡率的升高与胰岛素的使用相关[3]。本文旨在研究糖尿病胰岛素使用对复杂多支病变冠心病患者CABG术后早期预后的影响。 方法 本研究纳入广西医科大学第一附属医院2013年1月至2016年5月复杂病变冠心病合并糖尿病患者78例,这些患者均接受CABG全动脉搭桥手术治疗,55（70.5%）名患者为非胰岛素治疗的糖尿病患者,23（29.5%）名患者为使用胰岛素治疗的糖尿病患者,两组患者均采用乳内动脉+桡动脉全动脉搭桥方式,采用非体外循环搭桥术式。平均随访时间23个月。 结果 两组患者死亡率和心血管事件发生率上无明显差异（p=0.347）,5（6.4%）名患者术后发生心肌梗死的并发症,3（3.8%）名患者监护期间出现脑梗死。19（24.3%）名患者随访期间复查冠脉造影,其中2（2.5%）名患者的造影结果提示移植血管的功能病变,两组之间移植血管病变之间无明显差异。 结论 糖尿病患者胰岛素的使用对多支病变CABG全动脉搭桥手术患者的早期预后无显著影响,胰岛素的使用对于复杂多支病变合并糖尿病的患者仍有积极的治疗作用。
【关键字】全动脉搭桥术;糖尿病;死亡率;胰岛素 相似文献
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Michio Kuwahara Junichi Ishigami Satomi Shikuma Wataru Akita Yoshihiro Mori Tomoki Asai Yusuke Tsukamoto Susumu Adachi Yumi Noda Tatemitsu Rai Shinichi Uchida Sei Sasaki 《Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy》2012,16(6):541-547
Chronic kidney disease (CKD) increases the risk of developing cardiovascular diseases such as heart failure (HF) and ischemic heart disease (IHD). The characteristics of patients with CKD complicated with HF at the time of starting hemodialysis have not yet been evaluated. We enrolled 347 patients in this study and compared gender, age, body mass index, laboratory data, causative disease, complications, and echocardiographic findings between groups with (n = 105) and without (n = 242) HF. Type II diabetic nephropathy and estimated glomerular filtration rate (eGFR; mL/min/1.73 m2) were the independent factors for HF (OR: 3.004, 95% CI: 1.754 to 5.146 and OR: 1.215, 95% CI: 1.101 to 1.330, [per 1 mL/min/1.73 m2 increase], respectively). The higher GFR appeared to be not a risk factor for HF, probably because the HF group included patients who required periodic dialysis to prevent fatal HF, even if their renal function was not extremely deteriorated. The prevalence of hypertension, IHD and values of body mass index, triglycerides, and LDL‐cholesterol did not differ between these two groups. Echocardiographic data showed that left ventricular mass index was an independent risk factor for HF (OR: 1.006, 95% CI: 1.001 to 1.012, per 1 g/m2 increase) and more than half of the patients appeared to have left ventricular diastolic dysfunction. Our findings suggest that not only CKD, but also type II DM, is a potent risk for left ventricular dysfunction, which causes HF and IHD in pre‐dialysis patients with CKD. 相似文献
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Wei Huang Rudolf K.F. Oliveira Han Lei David M. Systrom Aaron B. Waxman 《Journal of cardiac failure》2018,24(3):169-176
Background
In heart failure with preserved ejection fraction (HFpEF), the prognostic value of pulmonary vascular dysfunction (PV-dysfunction), identified by elevated pulmonary vascular resistance (PVR) at peak exercise, is not completely understood. We evaluated the long-term prognostic implications of PV-dysfunction in HFpEF during exercise in consecutive patients undergoing invasive cardiopulmonary exercise testing for unexplained dyspnea.Methods
Patients with HFpEF were classified into 2 main groups: resting HFpEF (n?=?104, 62% female, age 61 years) with a pulmonary arterial wedge pressure (PAWP)?>15?mmHg at rest; and exercise HFpEF (eHFpEF; n?=?81) with a PAWP?<15?mmHg at rest, but >20?mmHg during exercise. The eHFpEF group was further subdivided into eHFpEF + PV-dysfunction (peak PVR?≥80 dynes/s/cm?5; n?=?55, 60% female, age 64) group and eHFpEF – PV-dysfunction (peak PVR?<80 dynes/s/cm?5; n?=?26, 42% female, age 54 years) group. Outcomes were analyzed for the first 9 years of follow-up and included any cause mortality and heart failure (HF)-related hospitalizations. The mean follow-up time was 6.7?±?2.6 years (0.5–9.0).Results
Mortality rate did not differ among the groups. However, survival free of HF-related hospitalization was lower for the eHFpEF + PV-dysfunction group compared with eHFpEF – PV-dysfunction (P?=?.01). These findings were similar between eHFpEF + PV-dysfunction and the resting HFpEF group (P?=?.774). By Cox analysis, peak PVR ≥80 dynes/s/cm?5 was a predictor of HF-related hospitalization for eHFpEF (hazard ratio 5.73, 95% confidence interval 1.05–31.22, P?=?.01). In conclusion, the present study provides insight into the impact of PV-dysfunction on outcomes of patients with exercise-induced HFpEF. An elevated peak PVR is associated with a high risk of HF-related hospitalization. 相似文献15.
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Diabetes mellitus is the most important risk factor of coronary heart disease ( CHD ) . In the recent years, diabetes has been recognised as a condition being as risky as CHD; so, much attention is being laid on the relationship between type 2 diabetes mellitus (T2DM) and CHD. There are a whole lot of cardiovascular risk factors which gather under T2DM. These include: dis- turbances of the clotting and fibrinolytic system, in- flammation , dysfunction of the endothelial cells and ir- reg… 相似文献
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探讨心率变异 (HRV)三角指数和平均心率 (mHR)评价慢性心力衰竭 (简称心衰 )患者心功能状态的价值。应用动态心电图分析系统和彩色超声心动图对慢性心衰患者 (36例 )及健康对照组 (36例 )进行左室射血分数(LVEF)、左室舒张末内径 (LVd)、2 4hHRV三角指数和mHR等参数测量。结果 :①心衰组与对照组比较 ,mHR ,三角指数 ,LVd ,LVEF均有显著统计学差异 ,P <0 .0 1。②心衰组中三角指数和mHR与LVEF具有相关性 (r分别为- 0 .743,- 0 .6 35 ,P <0 .0 5及 0 .0 1)。③三角指数与mHR在心衰组中具有相关性 (r=0 .2 9,P =0 .0 0 8) ,在对照组中不具有相关性 (r=0 .33,P =0 .38)。结论 :在慢性心衰患者中 ,三角指数和mHR对于评价心衰患者心功能具有一定意义 相似文献