2型糖尿病患者肾动脉阻力与左室舒张功能障碍的关系
发布时间:2018-01-29 18:29
本文关键词: 动脉硬化 组织多普勒 2型糖尿病 肾动脉 血管阻力 出处:《大连医科大学》2014年硕士论文 论文类型:学位论文
【摘要】:目的:糖尿病可引起大血管弹性降低、管壁僵硬已被广泛证实,而糖尿病引起终末器官小血管病变的研究甚少。本研究旨在探究2型糖尿病患者肾动脉阻力与左室舒张功能之间的相关性。 方法:选取2012年7月至2013年10月在我院内分泌科初次确诊的2型糖尿病人80例,健康对照组40例。超声诊断仪器采用Philips IU22,所有被检者采取卧位或侧卧位,彩色超声多普勒模式下清晰显示双侧肾各级动脉血流情况,利用频谱多普勒测量肾中部叶间动脉的收缩期峰值流速Vs,舒张末期流速Vd,阻力指数RI=(Vs-Vd)/Vs,每侧肾至少三次取样求平均值作为最终参数;超声心动图常规测量左房内径LAD,室间隔厚度IVS,左室后壁厚度LVPW等,脉冲多普勒模式下在心尖四腔观,测量二尖瓣口血流舒张早期最大流速(E)、二尖瓣口血流心房收缩期最大流速(A),主动脉血流频谱终点至二尖瓣血流频谱始点的时间即等容舒张时间IRT,并计算E/A比值,接着应用组织多普勒TDI,将2mm脉冲多普勒取样框放置在二尖瓣环室间隔侧得到舒张早期最大运动速度(E'),并计算E/E’。生化常规指标为入院时的检测结果。两组间各类参数进行对比分析。 结果:1.肾动脉阻力指标:糖尿病组的肾动脉RI(0.66±0.05)高于健康对照组(0.54±0.08,P0.05),糖尿病组舒张末期流速Vd(9.79±5.17)低于健康对照组(14.99±8.19,P0.05),差异均有统计学意义。2.超声心动图参数:健康组与糖尿病组的心脏参数E’、E/E’比值、LVPW之间有统计学差异,(E’:11.4±1.5,9.7±1.6,P0.05;E/E’:9.6±2.3,10.3±3.0,P0.05,LVPW:8±1,,10±1,P0.05)。而代表收缩功能的LVEF%、FS%两组间也没有统计学差异。3.肾动脉RI与心脏参数的相关分析:RI与E/E’比值(r=0.31,P0.001)、LAD(r=0.36,P0.05)呈正相关,与E/A比值(r=-0.36,P0.05)呈负相关,其中,与E/E’比值的相关性最强。4.E/E’比值与临床生化指标的相关性:E/E’比值与年龄、糖尿病病程、收缩压SBP、血肌酐、尿白蛋白排泄率都呈正相关,与肾小球滤过率估测值eGFR呈负相关。多元线性回归分析后,糖尿病病程(β=0.322,p0.001)、尿白蛋白排泄率β=0.431,p0.001)是E/E'比值的独立危险因素。 结论:2型糖尿病患者早期不仅出现肾小动脉阻力增加,还有左室舒张功能障碍,且随着肾小动脉阻力升高,左室舒张功能逐渐减低。
[Abstract]:Objective: diabetes mellitus can cause the reduction of macrovascular elasticity, and the wall stiffness has been widely confirmed. However, there are few studies on the end organ microvascular lesions caused by diabetes. This study aims to explore the correlation between renal artery resistance and left ventricular diastolic function in type 2 diabetes mellitus. Methods: from July 2012 to October 2013, 80 patients with type 2 diabetes were selected. Philips IU22 was used as the ultrasonic diagnostic instrument. All the subjects were in the supine position or lateral position. The blood flow of bilateral renal arteries was clearly displayed in color Doppler mode. The peak systolic velocity (V _ s), the end-diastolic velocity (V _ d) and the resistance index (RI=(Vs-Vd)/Vs) of the interlobar artery were measured by spectral Doppler. The average value of each kidney was obtained at least three times as the final parameter. Left atrial diameter (lad), ventricular septal thickness (IVS) and left ventricular posterior wall thickness (LVPW) were measured by echocardiography. The peak flow velocity in early diastolic phase of mitral orifice and atrial systolic velocity in mitral orifice were measured. The end point of aortic flow spectrum to the beginning point of mitral flow spectrum was isovolumic relaxation time (IRTT). The ratio of E / A was calculated and then tissue Doppler TDI was used. A 2mm pulsed Doppler sampling frame was placed on the septal side of the mitral annulus to obtain the maximum early diastolic velocity. The biochemical routine indexes were measured at admission. The parameters of the two groups were compared and analyzed. Results 1.Renal artery resistance index: the renal artery RI(0.66 卤0.05 in the diabetic group was higher than that in the healthy control group (0.54 卤0.08, P 0.05). The end-diastolic velocity (Vd(9.79 卤5.17) in the diabetic group was lower than that in the control group (14.99 卤8.19) (P 0.05). Echocardiographic parameters: the heart parameters of healthy group and diabetes group were significantly different (P < 0.05). There was significant difference in the ratio of E / E / E 'between healthy group and diabetic group. There was significant difference between LVPW and EW: 11.4 卤1.5. 9.7 卤1.6 P0.05; E / E: 9. 6 卤2. 3 + 10. 3 卤3. 0 P0. 05% LVPWW: 8 卤1 + 10 卤1 + P0. 05%, and LVEF%, which represents contraction function. There was also no statistical difference between the two groups. The correlation between RI of renal artery and heart parameters was analyzed. The ratio of RI to E / E was 0.31% P 0.001 / 0.36. There was a positive correlation between P0.05) and a negative correlation with the ratio of E / A to 0.36 (P0.05). The correlation between E / E 'ratio and clinical biochemical index was the strongest. 4. The correlation between E / E' ratio and clinical biochemical indexes:% E / E 'ratio and age, course of diabetes, SBP, creatinine. Urinary albumin excretion rate was positively correlated and negatively correlated with glomerular filtration rate (eGFR). After multiple linear regression analysis, the course of diabetes mellitus (尾 -0.322 p 0.001). Urinary albumin excretion rate (尾 -0.431g, p 0.001) is an independent risk factor of E / E 'ratio. Conclusion in the early stage of type 2 diabetes mellitus, the resistance of renal arterioles and left ventricular diastolic dysfunction were increased, and the left ventricular diastolic function decreased gradually with the increase of resistance of renal arterioles.
【学位授予单位】:大连医科大学
【学位级别】:硕士
【学位授予年份】:2014
【分类号】:R587.1;R445.1
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