降糖速率对2型糖尿病合并冠心病患者左心功能影响

目的 研究降糖速率对2型糖尿病患者左心功能变化的影响.方法 对132例2型糖尿病患者和135例2型糖尿病合并冠心病患者强化降糖治疗,分析不同降糖速率下左心室射血分数(LVEF)、左心室舒张早、晚期充盈速度比(E/A)变化.结果 2型糖尿病组降糖速率≤6 mmol·L-1·-1及2型糖尿病合并冠心病组降糖速率≤4 mmol·L-1·d-1时LVEF较降糖前显著升高(P＜0.05);2型糖尿病合并冠心病组降糖速率＞4 mmol·L-1·d-1时LVEF较降糖前显著降低(P＜0.05),但随访时LVEF升高,亚组间比较差异无统计学意义(P＞0.05).各亚组内比较降糖后E/A均升高(P＜0.05).结论 2型糖尿病合并冠心病患者降糖速率过快会导致左心功能受损;血糖长期良好控制会修复降糖速率过快对左心功能的损伤.不论有无冠心病,降糖速率如何,强化降糖后最终左心舒张功能均改善.

Influence of glucose-lowering rate on left ventricular function in type 2 diabetes mellitus patients with coronary heart disease

Objective To explore the influence of glucose-lowering rate on left ventricular function in patients with type 2 diabetes mellitus (T2DM). Methods One hundred and thirty-two cases of type 2 diabetes mellitus and 135 cases of type 2 diabetes mellitus with coronary heart disease (T2DM+CHD)received intensive glucose lowering therapy. Then, after measuring left ventricular ejection fraction (LVEF) and E/A ratio, the variation was analyzed. Results LVEF was significantly higher than that before intensive therapy in T2DMsubgroup with glucose-lowering rate less than 6 m mol · L-1 · d-1( P＜0.05 ). So was T2DM+CHD subgroup with glucose-lowering rate less than 4 mmol· L-1 · d-1 (P＜0.05). LVEF was significantly lower than that before intensive therapy in T2DM+CHD subgroup with glucose-lowering rate greater than 4 mmol · L-1 · d-1( P＜0. 05 ),while by the end of following up for 3 months, LVEF stepped up and no significant difference was observed between subgroups ( P ＞ 0. 05 ). The E/A ratio stepped up in both subgroups after intensive therapy ( P ＜ 0. 05 ).Conclusions For T2DM patients with coronary heart disease, excessively fast glucose-lowering rate may impair left ventricular function. Long-term good control of blood glucose restores the impaired left ventricular function causes by excessively fast glucose-lowering rate. After intensive therapy, left ventricular diastolic function finally improves in both subgroups regardless of the glucose-lowering rate and coronary heart disease.