糖代谢异常对原发性高血压患者左心室功能的影响

目的 探讨糖代谢异常（impaired glucose metabolism，IGM）对原发性高血压（essential hypertension，EH）患者左心室收缩和舒张功能的影响。方法选取46例单纯EH（单纯EH组）及36例合并2型糖尿病（T2DM）的EH患者（合并T2DM组），检测其血糖、血脂、血尿酸、纤维蛋白原等代谢参数，同时行心脏超声多普勒获取左心室收缩及舒张功能参数。对比2组患者的各项代谢参数及左心室收缩与舒张功能参数的差异，并对左心室功能异常的EH患者与无左心室功能异常的EH患者糖代谢状态进行分析。结果合并T2DM组患者体质量指数、空腹血糖、餐后2h血糖（PBG）、糖化血红蛋白（HbAlc）、三酰甘油、总胆固醇、低密度脂蛋白胆固醇、载脂蛋白B、尿酸及纤维蛋白原等水平均显著高于单纯EH组（P〈0．05或P〈O．01）。心脏超声多普勒检查结果显示，所有EH患者均未出现左心室收缩功能不全（左心室射血分数〈40％），而合并T2DM组左心室舒张功能障碍发生率显著高于单纯EH组（P〈O．05）。进一步分析发现，左心室舒张功能障碍EH患者合并T2DM的发病率显著高于无左心室舒张功能障碍的EH患者，且出现左心室舒张功能障碍的EH患者空腹血糖及HbAlc水平均显著高于无左心室舒张功能障碍的EH患者（P均〈0．01），但2者之间PBG的差异则无统计学意义（P〉0．05）。结论糖代谢异常可加重EH患者左心室功能不全，尤其是早期心脏舒张功能障碍；改善EH患者的糖代谢状态，可能有助于延缓其左心功能异常的出现。

Effects of impaired glucose metabolism on left ventricular function in essential hypertensive patients

Objective To explore the effects of impaired glucose metabolism （IGM） on left ventricular function in essential hypertensive（EH） patients. Methods Comparative assessment on metabolic parameters such as body mass index（ BMI）, blood glucose, blood lipidogram, serum uric acid（UA） and fibrinogen（ Fib）, as well as left ventricular function index obtained by Doppler echocardiography were carried out between 46 cases of simple EH and 36 cases of EH combined with type 2 diabetes mellitus （T2DM）. In the meanwhile, The difference of blood glucose metabolism among those EH patients with or without left ventricular diastolic dysfunction（LVDD） were also analyzed. Results In comparison with the EH group, the EH combined with T2DM group had significantly higher level of body mass index （ BMI）, fasting blood glucose （FBG）, postprandial blood glucose （PBG）, hemoglobin Ale（ HbAlc）, triacylglyeerols （TG）, low density lipoprotein cholesterol （LDL-C）, apo-B, UA and Fib（P〈0. 05 or P〈0.01）. In addition, Doppler echocardiography examination revealed that the occurrence of LVDD was higher in the EH combined with T2DM group than that in EH group （ 72. 2% vs 45.7%, P〈0. 05 ）. There was no cases of left ventricular systolic dysfunction （represented as left ventricular ejection fraction less than 0. 4） in all the EH patients with or without T2DM. Furthermore, the morbidity of T2DM in those EH patients with LVDD was higher than that of those EH patients without LVDD （ 55.3% vs 28.6%, X2 = 5. 828, P= 0. 016）, and the levels of FBG [（6.19 ± 1.06） mmol/L vs （5.44 ±0.81） retool/L, P=0. 001] and HbAlc（6.54 ± 0.95 vs 5.87 ± 0. 89, P=0. 002） in the EH patients with LVDD were all higher than those of the EH patients without LVDD significantly. There was no significant difference of PBG among these two groups of EH patients [ （8.41 ± 1.44） mmol/L vs （7.85± 1.31 ） mmoL/L, P= 0. 074]. Conclusions In the EH patients, impaired glucose metabolism might aggravate left ventrieular dysfunction, especially inducing early left ventricular diastolic dysfunction（LVDD） , which means that improvement of glucose metabolism could be benefit to retarding the occurrence of left ventricular dysfunction.