不同血糖控制水平对2型糖尿病患者左室结构和功能的影响

目的 探讨不同血糖控制水平对2型糖尿病患者左室结构和功能的影响。方法 选择2009年9月~2011年1月于巴中市中心医院就诊的2型糖尿病患者40例作为糖尿病组，另选择性别年龄匹配的健康志愿者40例为正常对照组。对糖尿病组患者进行规范化治疗，观察期24个月，比较治疗前后患者左室结构和功能的超声学参数。随访末，根据血糖控制水平将糖尿病组分为良好组(HbA1c<7.6%，n=17)、中等组(7.6%≤HbA1c≤9%，n=14)和不良组(HbA1c>9%，n=9) 3个亚组，比较随访前后3组的超声学参数的变化。结果 在基线水平糖尿病等容舒张期时间（IVRT）糖尿病组明显高于对照组(P<0.05)，E/A低于对照组(P<0.05)，两组在室间隔厚度（IVS）、左室后壁厚度（LVPW）、左室舒张末内径（LVEDD）及左室收缩功能等方面差异无统计学意义；随访前后，血糖控制良好组左室结构和功能超声参数差异无统计学意义；中等组和不良组不同程度地出现IVS、LVPW及左室质量指数(LVMI)增加， IVRT延长和E/A降低，差异均有统计学意义(P<0.05)。结论 2型糖尿病患者容易发生左室舒张功能减退，积极控制血糖可以延缓左室肥厚的发生，但不能改善左室舒张功能，血糖控制不良会加速左室重构和加重左室舒张功能不全。

Effect of glycemic control on progression of left ventricular hypertrophy and diastolic dysfunction in patients with type 2 diabetes mellitus

AIM To investigate the effect of glycemic control on the progress of left ventricular hypertrophy and diastolic dysfunction in patients with type 2 diabetes mellitus (T2DM). METHODS A total of 40 T2DM patients (observation group) and 40 age-matched healthy controls (control group) were recruited. Patients in the observation group received standard treatment for glycemic control (including diabetes education, self-blood glucose monitoring and daily exercise). All patients were followed-up after 24 months and were evaluated by echocardiography to compare the left ventricular structural and functional parameters. At the end of our study, patients in the observation group were stratified into three subgroups according to glycemic level: well-controlled group (HbA1c<7.6%, n=17), mildy controlled group (7.6%≤HbA1c≤ 9%, n=14), and poorly controlled group (HbA1c>9%, n=9) respectively. Echocardiographic parameters were compared among the three groups before and after follow-up. RESULTS IVSd, LVPW, LVEDd and cardiac systolic function were similar between groups. IVRT was elevated but E/A decreased in the observation group compared with those in the control group at baseline (P<0.05). No significant differences were found in the echocardiographic parameters of left ventricular structure and function in well-controlled patients. The mildly controlled group and poorly controlled group demonstrated increased IVSd, LVPWd and LVMI, and exacerbated left ventricular diastolic function with prolonged IVRT and decreased E/A. In addition, patients receiving metformin therapy demonstrated a significant reduction in IVRT and E/A compared with patients receiving insulin therapy. CONCLUSION ST2DM patients tend to develop left ventricular diastolic dysfunction. Improved glycemic control can delay the progress of LVH, but cannot ameliorate the decreased diastolic dysfunction. Poor glycemic control can accelerate left ventricular remodeling and exacerbate diastolic dysfunction in patients with T2DM.