2型糖尿病患者心脏结构和功能变化及相关危险因素分析

摘要

目的：探讨2型糖尿病患者心脏结构及功能的变化和引起心衰的相关危险因素，提高对糖尿病慢性心血管并发症的认识。方法随机选择170例2型糖尿病患者为研究对象，170例非糖尿病患者为对照组，并分别按是否合并心衰分为心衰患者和非心衰患者。比较2组患者左室后壁厚度（LVPWTH）、左室舒张末期内径（LVEDD）、左室收缩末期内径（ LVESD）、左室射血分数（ LVEF）和 E/A 的差异，采用 Logistic 回归分析引发心衰的相关危险因素。结果2型糖尿病组LVPWTH、LVEDD、LVESD增加，LVEF减少，E/A 降低，与对照组比较差异有统计学意义（ p＜0.05），其差异主要来自非心衰患者；回归分析显示，糖尿病病程、HbA1c达标情况及合并症高血压、冠心病、血脂异常等是2型糖尿病并发心衰的危险因素（均p＜0.05）。结论糖尿病导致心脏重构以及收缩和舒张功能障碍，即使无临床心衰症状的患者，心脏结构及功能可能已经出现异常。因此，应注意早期进行心脏检查及心功能评价，积极防治相关危险因素，避免心衰的发生。%Objective To investigate the changes of cardiac structure and function in type 2 diabetes mellitus (T2DM), analyze the related risk factors of heart failure, and improve the awareness of the effect of diabetes on the heart. Methods Randomly selected 170 cases of T2DM patients As the object of study, 170 cases of non diabetic patients as con-trol group, according to whether complicated with heart failure were divided into heart failure patients and non heart failure patients.Comparison of each group left ventricular posterior wall thickness, left ventricular end diastolic diameter, left ven-tricular end systolic diameter, left ventricular ejection fraction, E/A ratio Differences, analysis of the related risk factors of heart failure by logistic regressive.Results T2DM group left ventricular posterior wall thickness, left ventricular end diastolic diameter and left ventricular end systolic diameter increased , Left ventricular ejection fraction decreased, E/A ratio de-creased, were statistically significant difference compared with the control group (p <0.05).These differences are mainly come from non heart failure patients.Logistic regression showed that factors in patients with diabetes duration, HbA1c, com-pliance and complications of hypertension, coronary heart disease, is a risk factor for heart failure complicated with T2DM (all p<0.01).These may be the risk factor for diabetic patients with heart failure.Conclusion Diabetes can cause cardiac remodeling, systolic and diastolic dysfunction maybe some T2DM patients.They did not show symptoms of heart failure in the clinical, but their Cardiac structure and function are abnormal.We should pay attention to the cardiac function examination and early evaluation, prevention of risk factors, to avoid the occurrence of heart failure.