采用超声技术探讨2型糖尿病患者心功能与动脉硬化的关联

目的初步探讨2型糖尿病患者心功能与全身系统动脉硬化的关联关系。方法 2型糖尿病患者75例,收缩心功能正常组(A组LVEF≥50%)45例,心功能不全组(B组LVEF<50%)30例;正常对照组40例。测量左室结构、功能及血流动力学参数,计算左室壁相对厚度及心肌耗氧参数。测量静息状态下左侧肱动脉压。计算有效动脉弹性(Ea)=左室收缩末压/每搏输出量,其中左室收缩末压=0.9×肱动脉收缩压。1周后随机选取15例行Ea重复试验。采用多元线性逐步回归,筛选Ea的独立关联指标。结果糖尿病B组患者较糖尿病A组和对照组心肌氧耗参数心率血压二重乘积增高(P<0.01)。糖尿病A组的左室收缩末压和RPP与糖尿病B组间的差异有统计学意义(P<0.01)。左室相对厚度和Ea在三组间差异有统计学意义(P<0.01),射血分数在糖尿病组间差异有统计学意义(P<0.01);糖尿病组间,高密度脂蛋白胆固醇和血糖差异有统计学意义(P<0.05～0.01)。糖尿病A组甘油三脂、低密度脂蛋白胆固醇和血糖与对照组间差异有统计学意义(P<0.05～0.01);以Ea为应变量,行多元线性回归分析,进入方程的变量有:心率血压二次乘积、高密度脂蛋白胆固醇、血糖、室壁相对厚度和射血分数,其标准回归系数(及回归系数)分别为0.13(0.11)、-0.17(-0.89)、-0.29(-0.19)、0.24(4.78)和0.48(0.06)。Ea重复性测量组内比较具有高的一致性(r=0.96,P<0.001),平均差异(0.022±0.175)mmHg/ml。结论 2型糖尿病患者动脉硬化,心功能、心肌耗氧参数和生化指标是其独立的危险因素。

A study on the relations between cardiac function and arteriosclerosis in patients with type 2 diabetes mellitus using echocardio- graphy

Objective To preliminarily explore the relation between cardiac function and arteriosclerosis in patients with type 2 diabetes mellitus （T2DM） based on echoeardiography. Methods Seventy-five patients with T2DM were divided in- to two groups, group A in 45 T2DM with normal ventricular systolic function, ejection fraction of left ventricular （LVEF） ≥50%, and group B in 30 T2DM with cardiac insufficiency, LVEF〈50%. The 40 healthy cases was control group. The parameters of structure and function of left ventricle, blood flow were measured. The relative thickness of left ventricle and consumption of myocardium oxygen （rate pressure product, RPP） were calculated. At resting condition, the pressure of left brachial artery was measured and the arterial elastance index （Ea） was calculated （Ea=EPS/SV, EPS was LV end- systolic pressure and was 0.9 X systolic blood pressure）. Fifty cases were randomly selected 1week later, and Ea was ana- lyzed by repeatability test. The indicators associated with Ea were selected by multiple linear stepwise regressions. Results The RPP in group B with T2DM was increased than group A and control group. The ESP and RPP in group A and B with T2DM had statistical significance （ P 〈0.01）. The relative thickness of left ventricle and Ea showed significant difference among group A, B and control group （ P〈0. 01）. Compared with group A, LVEF in group B was significantly lower （ P 〈0.01）. The high density lipoprotein and blood glucose were significantly differences between group A and B with T2DM （ P 〈0.01）. The levels of triglycerides, low density lipoprotein and blood glucose were significantly differences between group A with T2DM and control group （ P 〈0.05-0.01）. Logistic regression showed that RPP, high density lipopro rein, blood glucose, relative thickness of left ventricle and LVEF were main factors of Ea. The standardized coefficients and coefficients were 0.13（0.11） , -0.17（-0.89）, -0.29（-0.19）, 0.24（4.78） and 0.48（0.06） respectively. Repeatability test showed Ea in the inter-group was high consistency（ r =0.96, P G0. 001）, and mean difference was（0. 0224-0. 175） mmHg/ml. Conclusion Artery was sclerosis in T2DM and the cardiac function, consumption of myocardium oxygen and biochemical parameter were significant contributor to arteriosclerosis.