2型糖尿病患者低水平白蛋白尿和左室舒张功能及左室重构的关系
发布时间：2018-09-10 13:48
【摘要】：背景:低水平白蛋白尿(LGA)(30 mg/g)被认为和心血管疾病风险的增高相关。我们旨在研究2型糖尿病患者中,正常尿白蛋白肌酐比值(UACR)和左室舒张功能及左室重构的关系。方法:888例2010年6月至2014年9月就诊于福建医科大学附属第一医院内分泌科UACR正常(30 mg/g)的2型糖尿病患者(465名男性和423名女性)参与了这项回顾性研究。依据UACR分为四组(0.90-5.87,5.87-9.17,9.17-15.30,15.30-30.00mg/g)。通过心脏彩超测得计算舒张早期二尖瓣口速度(E),平均舒张早期二尖瓣环速度(平均e),左室重量指数(LVMI),相对室壁厚度(RWT)。左室舒张功能通过E/e和平均e评估,左室重构通过体表面积标准化的左室质量(LVMI)和相对室壁厚度(RWT)评估。结果:1.不同UACR水平的2型糖尿病患者出现亚临床左室舒张功能障碍的频率为Q1(42.3%)Q2(52.7%)Q3(56.8%)Q4(65.3%)(P0.001),出现左室重构的频率为Q1(17.6%)Q2(27.0%)Q3(30.6%)Q4(35.1%)(P0.001),不同UACR水平的2型糖尿病患者出现亚临床左室舒张功能障碍及左室重构频率随着UACR分组均有升高的趋势。2.在调整年龄、性别、糖尿病病程、收缩压、舒张压、eGFR、Hb A1c、BMI后,UACR和平均e,E/e,LVMI显著相关(β=-0.004,p0.001;β=0.081,p0.001;β=0.383,p0.001),和RWT不相关。3.在logistic回归分析中,调整年龄、性别、糖尿病病程、收缩压、舒张压、e GFR、Hb A1c、BMI、吸烟史、饮酒史及用药史后,最高四分位组的病人患左室舒张功能障碍的风险可能是最低四分位组的病人的1.625倍(OR=1.625,95%CI=1.029-2.568,P=0.037),而第三及第四组的病人左室重构风险分别是最低组的病人的1.729倍及1.994倍(OR=1.729,95%CI=1.064-2.810,P=0.027;OR=1.994,95%CI=1.232-3.227,P=0.005)。4.UACR和亚临床心脏舒张功能障碍的关系在小于60岁,病程短于10年,非肥胖或未合并高血压病的女性患者中仍存在。UACR和左室重构的联系在非肥胖、年长、低密度脂蛋白胆固醇正常水平、病程短于10年、无高血压病的男性患者中仍然存在。结论:2型糖尿病患者中,正常高水平UACR和亚临床左室舒张功能障碍及左室重构相关。LGA和心血管疾病风险相关,可能是2型糖尿病患者亚临床心血管损伤的标志。
[Abstract]:Background: low-level albuminuria (LGA) (30 mg/g) is associated with increased risk of cardiovascular disease. We investigated the relationship between (UACR), left ventricular diastolic function and left ventricular remodeling in patients with type 2 diabetes. Methods from June 2010 to September 2014, a total of 888 type 2 diabetic patients (465 males and 423 females) with normal UACR (30 mg/g) from the Department of Endocrinology, first affiliated Hospital of Fujian Medical University, participated in the retrospective study. According to UACR, they were divided into four groups (0.90-5.87, 5.87-9.17, 9.17-15.30, 15.30-30.00mg / g). Calculation of early diastolic mitral orifice velocity by color Doppler echocardiography (E), mean early diastolic mitral annular velocity (mean e), left ventricular mass index (LVMI), relative wall thickness (RWT).) Left ventricular diastolic function was evaluated by E / e and mean e, and left ventricular remodeling was assessed by (LVMI) and relative wall thickness (RWT). The result is 1: 1. The frequency of subclinical left ventricular diastolic dysfunction in type 2 diabetic patients with different UACR levels was Q1 (42.3%), Q2 (52.7%), Q3 (56.8%), Q4 (65.3%) (P0.001), Q1 (17.6%), Q2 (27.0%), Q3 (30.6%) (P0.001), subclinical left ventricular diastolic dysfunction and left ventricular diastolic dysfunction (P0.001) in patients with type 2 diabetes with different UACR levels. The frequency of ventricular remodeling increased with the grouping of UACR. After adjusting for age, sex, course of diabetes, systolic blood pressure, diastolic blood pressure (DBP), RWT was not correlated with mean ER (尾 -0.004, p0.001; 尾, 0.081, p0.001; 尾, 0.383p0.001), and was not correlated with RWT. In logistic regression analysis, age, sex, course of diabetes, systolic blood pressure, diastolic blood pressure, smoking history, drinking history and drug use history were adjusted. The risk of left ventricular diastolic dysfunction in the highest quartile group was 1.625 times higher than that in the lowest quartile group (OR=1.625,95%CI=1.029-2.568,P=0.037), while the risk of left ventricular remodeling in the third and fourth groups was 1.729 and 1.994 times higher than that in the lowest group, respectively (OR=1.729,95%CI=1.064-2.810,P=0.027;OR=1.994,95%CI=1.232-3.227,P=0.005. The relationship between subclinical cardiac diastolic dysfunction and subclinical diastolic dysfunction is less than 60 years old. The course of disease was less than 10 years, and the relationship between .UACR and left ventricular remodeling was found in non-obese women or women without hypertension in normal levels of non-obese, elderly, low-density lipoprotein cholesterol, and the course of disease was shorter than 10 years. Male patients without hypertension are still present. Conclusion in patients with type 2 diabetes mellitus, normal high level of UACR is associated with subclinical left ventricular diastolic dysfunction, left ventricular remodeling and cardiovascular disease risk, which may be a marker of subclinical cardiovascular injury in type 2 diabetes mellitus.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1
[Abstract]:Background: low-level albuminuria (LGA) (30 mg/g) is associated with increased risk of cardiovascular disease. We investigated the relationship between (UACR), left ventricular diastolic function and left ventricular remodeling in patients with type 2 diabetes. Methods from June 2010 to September 2014, a total of 888 type 2 diabetic patients (465 males and 423 females) with normal UACR (30 mg/g) from the Department of Endocrinology, first affiliated Hospital of Fujian Medical University, participated in the retrospective study. According to UACR, they were divided into four groups (0.90-5.87, 5.87-9.17, 9.17-15.30, 15.30-30.00mg / g). Calculation of early diastolic mitral orifice velocity by color Doppler echocardiography (E), mean early diastolic mitral annular velocity (mean e), left ventricular mass index (LVMI), relative wall thickness (RWT).) Left ventricular diastolic function was evaluated by E / e and mean e, and left ventricular remodeling was assessed by (LVMI) and relative wall thickness (RWT). The result is 1: 1. The frequency of subclinical left ventricular diastolic dysfunction in type 2 diabetic patients with different UACR levels was Q1 (42.3%), Q2 (52.7%), Q3 (56.8%), Q4 (65.3%) (P0.001), Q1 (17.6%), Q2 (27.0%), Q3 (30.6%) (P0.001), subclinical left ventricular diastolic dysfunction and left ventricular diastolic dysfunction (P0.001) in patients with type 2 diabetes with different UACR levels. The frequency of ventricular remodeling increased with the grouping of UACR. After adjusting for age, sex, course of diabetes, systolic blood pressure, diastolic blood pressure (DBP), RWT was not correlated with mean ER (尾 -0.004, p0.001; 尾, 0.081, p0.001; 尾, 0.383p0.001), and was not correlated with RWT. In logistic regression analysis, age, sex, course of diabetes, systolic blood pressure, diastolic blood pressure, smoking history, drinking history and drug use history were adjusted. The risk of left ventricular diastolic dysfunction in the highest quartile group was 1.625 times higher than that in the lowest quartile group (OR=1.625,95%CI=1.029-2.568,P=0.037), while the risk of left ventricular remodeling in the third and fourth groups was 1.729 and 1.994 times higher than that in the lowest group, respectively (OR=1.729,95%CI=1.064-2.810,P=0.027;OR=1.994,95%CI=1.232-3.227,P=0.005. The relationship between subclinical cardiac diastolic dysfunction and subclinical diastolic dysfunction is less than 60 years old. The course of disease was less than 10 years, and the relationship between .UACR and left ventricular remodeling was found in non-obese women or women without hypertension in normal levels of non-obese, elderly, low-density lipoprotein cholesterol, and the course of disease was shorter than 10 years. Male patients without hypertension are still present. Conclusion in patients with type 2 diabetes mellitus, normal high level of UACR is associated with subclinical left ventricular diastolic dysfunction, left ventricular remodeling and cardiovascular disease risk, which may be a marker of subclinical cardiovascular injury in type 2 diabetes mellitus.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1
【参考文献】
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1 李蓉;王华斌;刘蕊;崔小t，
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