2型糖尿病合并非酒精性脂肪性肝病患者高同型 半胱氨酸与心脏舒张功能的关系

目的　探讨2型糖尿病（T2DM）合并非酒精性脂肪性肝病（NAFLD）患者高同型半胱氨酸（Hcy）对心脏舒张功能的影响。方法　182例T2DM患者按照是否合并NAFLD、高Hcy（HHcy，Hcy＞15 μmol/L）交叉分组，分为非NAFLD&非HHcy（A）组46例，NAFLD&非HHcy（B）组48例、非NAFLD&HHcy（C）组42例、NAFLD&HHcy（D）组46例。分析NAFLD和HHcy对患者临床指标的影响。94例T2DM合并NAFLD患者按照舒张早期血流峰值速度（E）/舒张晚期血流峰值速度（A）分为心脏舒张功能正常组（E/A>0.8）和心脏舒张功能异常组(E/A≤0.8)，比较分析2组间临床资料。Logistic回归分析影响T2DM合并NAFLD者心脏舒张功能的因素。结果　析因分析结果发现，NAFLD对体质量指数（BMI）、收缩压（SBP）、舒张压（DBP）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）、C反应蛋白（CRP）、E/A、三酰甘油（TG）、总胆固醇（TC）及糖化血红蛋白（HbA1c）有显著影响，HHcy对BMI、SBP、DBP、空腹血糖（FBG）、FINS、HOMA-IR、CRP、左室心肌质量指数（LVMI）、E/A有显著影响，两者对SBP、FINS、HOMA-IR、CRP、E/A的影响存在交互作用（P＜0.05）。94例T2DM合并NAFLD患者中，E/A异常组BMI、SBP、FINS、HOMA-IR、LVMI和HHcy比例高于正常组（P＜0.05）。回归分析显示，HHcy是影响T2DM合并NAFLD患者心脏舒张功能异常的独立危险因素。结论　T2DM合并NAFLD同时并发HHcy患者心脏舒张功能明显降低。HHcy是T2DM合并NAFLD患者心脏舒张功能下降的独立危险因素。

The relationship between homocysteine and cardiac diastolic function in patients of type 2 diabetes mellitus complicated with nonalcoholic fatty liver disease

Objective To investigate the effect of homocysteine (Hcy) on cardiac diastolic function in patients of type 2 diabetes mellitus (T2DM) combined with nonalcoholic fatty liver disease (NAFLD). Methods A total of 182 T2DM patients admitted to our hospital were divided into non-NAFLD and non-HHcy group (group A, n=46), NAFLD and non-HHcy group (group B, n=48), non-NAFLD and HHcy group (group C, n=42) and NAFLD and HHcy group (group D, n=46). The influence of NAFLD and HHcy on clinical indicators was analyzed. Ninety-four T2DM patients with NAFLD were divided into the normal diastolic function group (E/A>0.8) and the abnormal diastolic function group (E/A≤0.8) according to the diastolic peak velocity in the early phase (E)/the diastolic peak velocity in the late phase (A). The clinical data between the two groups were compared and analyzed. Logistic regression analysis was used to analyze the influencing factors of diastolic function in T2DM patients with NAFLD. Results The results of factorial analysis showed that NAFLD had significant effects on body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting insulin (FINS), insulin resistance index (HOMA-IR), C-reactive protein (CRP), E/A, triglyceride (TG), total cholesterol (TC) and glycosylated hemoglobin (HbA1c). HHcy showed significant effects on BMI, SBP, DBP, fasting blood glucose (FBG), FINS, HOMA-IR, CRP, LVMI and E/A. There was a interaction between them on SBP, FINS, HOMA-IR, CRP and E/A (P＜0.05). In 94 T2DM patients combined with NAFLD, the BMI, SBP, FINS, HOMA-IR, LVMI and incidence rate of HHcy were significantly higher in the E/A abnormal group than those in the normal group (P＜0.05). Regression analysis showed that HHcy was an independent risk factor for diastolic function in T2DM patients with NAFLD. Conclusion The diastolic function is significantly decreased in T2DM patients combined with NAFLD and HHcy. HHcy is an independent risk factor for decreasing diastolic function in T2DM patients combined with NAFLD.